SOFIA VARGAS
Dependent on policy B06M000171
Claims
3
Attributed to this person
Charged
1,238.00
Total submitted
Denied
853.00
2 denied claims
Patient responsibility
39.65
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 | SOFIA VARGAS |
| Role on the policy | Dependent · relationship 01 |
| Policy | B06M000171 |
| Date of birth | 24 Aug 1971 |
| Plan | BRONZE EPO |
| Covered from | 9 Jun 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 96 · Other | 1 | 39.65 |
| Total | 39.65 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000839 | 11 Jun 2026 | 853.00 | NORTHSTAR MUTUAL | CARC 18 · DUPLICATE | 853.00 |
| CLM0000840 | 3 Jun 2026 | 61.00 | NORTHSTAR MUTUAL | CARC 96 · NON_COVERED | 0.00 |
| CLM0000841 | 6 Nov 2025 | 324.00 | NORTHSTAR MUTUAL | Not denied | — |