DAVID VARGAS
Dependent on policy B06M000394
Claims
3
Attributed to this person
Charged
1,214.00
Total submitted
Denied
149.19
1 denied claims
Patient responsibility
91.35
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 | DAVID VARGAS |
| Role on the policy | Dependent · relationship 19 |
| Policy | B06M000394 |
| Date of birth | 2 Feb 1997 |
| Plan | GOLD PPO |
| Covered from | 1 Mar 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 91.35 |
| Total | 91.35 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001789 | 22 Aug 2026 | 249.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0001790 | 9 Mar 2024 | 356.00 | NORTHSTAR MUTUAL | CARC 109 · COB | 149.19 |
| CLM0001791 | 24 Feb 2024 | 609.00 | NORTHSTAR MUTUAL | Not denied | — |