HENRY NGUYEN
Dependent on policy B05M000611
Claims
3
Attributed to this person
Charged
1,552.00
Total submitted
Denied
468.00
2 denied claims
Patient responsibility
560.30
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 | HENRY NGUYEN |
| Role on the policy | Dependent · relationship 19 |
| Policy | B05M000611 |
| Date of birth | 6 Jan 1998 |
| Plan | SILVER HMO |
| Covered from | 4 Dec 2024 |
| Covered to | 7 May 2025 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 50 · Other | 1 | 560.30 |
| Total | 560.30 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002623 | 28 Jun 2025 | 862.00 | NORTHSTAR MUTUAL | CARC 50 · MEDICAL_NECESSITY | 0.00 |
| CLM0002621 | 3 Jan 2025 | 222.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0002622 | 4 Nov 2024 | 468.00 | NORTHSTAR MUTUAL | CARC 26 · ELIGIBILITY | 468.00 |