HENRY GARCIA
Subscriber on policy B06M000896
Claims
3
Attributed to this person
Charged
1,005.00
Total submitted
Denied
728.00
1 denied claims
Patient responsibility
30.00
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 GARCIA |
| Role on the policy | Subscriber |
| Policy | B06M000896 |
| Date of birth | 27 Nov 1989 |
| Plan | BRONZE EPO |
| Covered from | 2 Nov 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 3 · Copay | 1 | 30.00 |
| Total | 30.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003902 | 25 Aug 2025 | 208.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0003901 | 28 Jul 2025 | 69.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0003903 | 14 Oct 2024 | 728.00 | MERIDIAN HEALTH PLAN | CARC 26 · ELIGIBILITY | 728.00 |