VICTOR NGUYEN
Subscriber on policy B05M000164
Claims
3
Attributed to this person
Charged
1,392.00
Total submitted
Denied
299.00
1 denied claims
Patient responsibility
122.10
Reported on the 835
Patient responsibility is the amount reported on the 835 as assigned to the patient — deductible, coinsurance or copay. It is not proof that the provider billed the member, that the member owes it, or that it was collected, and it is kept separate from denied amounts throughout.
Who this is
| Field | Value |
|---|---|
| Name | VICTOR NGUYEN |
| Role on the policy | Subscriber |
| Policy | B05M000164 |
| Date of birth | 18 Jan 1971 |
| Plan | GOLD PPO |
| Covered from | 12 Jan 2024 |
| Covered to | 21 Jul 2024 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 122.10 |
| Total | 122.10 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000691 | 2 Aug 2024 | 299.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 299.00 |
| CLM0000690 | 9 Jun 2024 | 279.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0000692 | 2 May 2024 | 814.00 | NORTHSTAR MUTUAL | Not denied | — |