HENRY VARGAS
Dependent on policy B06M000713
Claims
3
Attributed to this person
Charged
1,293.00
Total submitted
Denied
508.00
1 denied claims
Patient responsibility
64.60
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 VARGAS |
| Role on the policy | Dependent · relationship 01 |
| Policy | B06M000713 |
| Date of birth | 20 Feb 1986 |
| Plan | GOLD PPO |
| Covered from | 24 Jan 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 64.60 |
| Total | 64.60 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003183 | 23 Aug 2026 | 462.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0003184 | 22 Aug 2025 | 323.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0003185 | 14 Apr 2025 | 508.00 | NORTHSTAR MUTUAL | CARC 29 · TIMELY_FILING | 508.00 |