GRACE GARCIA
Dependent on policy B06M000702
Claims
2
Attributed to this person
Charged
1,292.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
130.05
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 | GRACE GARCIA |
| Role on the policy | Dependent · relationship 01 |
| Policy | B06M000702 |
| Date of birth | 24 Oct 1947 |
| Plan | GOLD PPO |
| Covered from | 4 Apr 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 130.05 |
| Total | 130.05 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003124 | 11 Feb 2026 | 867.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0003125 | 23 Dec 2025 | 425.00 | NORTHSTAR MUTUAL | Not denied | — |