TOMAS NGUYEN
Dependent on policy B05M000230
Claims
3
Attributed to this person
Charged
1,172.00
Total submitted
Denied
273.00
1 denied claims
Patient responsibility
37.40
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 | TOMAS NGUYEN |
| Role on the policy | Dependent · relationship 01 |
| Policy | B05M000230 |
| Date of birth | 4 Oct 1986 |
| Plan | SILVER HMO |
| Covered from | 19 Nov 2024 |
| Covered to | 8 May 2025 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 37.40 |
| Total | 37.40 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000954 | 8 Apr 2025 | 187.00 | CASCADE CARE | Not denied | — |
| CLM0000955 | 31 Oct 2024 | 712.00 | CASCADE CARE | Not denied | — |
| CLM0000953 | 29 Oct 2024 | 273.00 | CASCADE CARE | CARC 26 · ELIGIBILITY | 273.00 |