CARLA NGUYEN
Dependent on policy B01M000499
Claims
1
Attributed to this person
Charged
487.00
Total submitted
Denied
0.00
1 denied claims
Patient responsibility
316.55
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 | CARLA NGUYEN |
| Role on the policy | Dependent · relationship 01 |
| Policy | B01M000499 |
| Date of birth | 13 Jun 1978 |
| Plan | BRONZE EPO |
| Covered from | 10 Sep 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 50 · Other | 1 | 316.55 |
| Total | 316.55 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002239 | 7 Jul 2025 | 487.00 | NORTHSTAR MUTUAL | CARC 50 · MEDICAL_NECESSITY | 0.00 |