VICTOR NGUYEN
Subscriber on policy B05M000611
Claims
3
Attributed to this person
Charged
1,322.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
46.05
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 | B05M000611 |
| Date of birth | 10 Feb 1963 |
| Plan | SILVER HMO |
| Covered from | 4 Dec 2024 |
| Covered to | 7 May 2025 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 46.05 |
| Total | 46.05 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002618 | 25 Apr 2025 | 462.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0002619 | 15 Apr 2025 | 307.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0002617 | 26 Feb 2025 | 553.00 | NORTHSTAR MUTUAL | Not denied | — |