DAVID GARCIA
Subscriber on policy B06M000791
Claims
1
Attributed to this person
Charged
631.00
Total submitted
Denied
631.00
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 | DAVID GARCIA |
| Role on the policy | Subscriber |
| Policy | B06M000791 |
| Date of birth | 29 May 1968 |
| Plan | GOLD PPO |
| Covered from | 12 Jul 2024 |
| Covered to | open |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003480 | 24 Apr 2025 | 631.00 | NORTHSTAR MUTUAL | CARC 18 · DUPLICATE | 631.00 |