AMARA GARCIA
Dependent on policy B01M000586
Claims
1
Attributed to this person
Charged
116.00
Total submitted
Denied
35.02
1 denied claims
Patient responsibility
0.00
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 | AMARA GARCIA |
| Role on the policy | Dependent · relationship 01 |
| Policy | B01M000586 |
| Date of birth | 17 Oct 1983 |
| Plan | SILVER HMO |
| Covered from | 6 Mar 2024 |
| Covered to | 9 Oct 2024 |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002614 | 20 Jun 2024 | 116.00 | NORTHSTAR MUTUAL | CARC 197 · AUTHORIZATION | 35.02 |