PRIYA GARCIA
Subscriber on policy B06M000895
Claims
3
Attributed to this person
Charged
1,585.00
Total submitted
Denied
187.00
2 denied claims
Patient responsibility
415.35
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 | PRIYA GARCIA |
| Role on the policy | Subscriber |
| Policy | B06M000895 |
| Date of birth | 18 Oct 2003 |
| Plan | GOLD PPO |
| Covered from | 28 Sep 2024 |
| Covered to | 1 Feb 2025 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 96 · Other | 1 | 415.35 |
| Total | 415.35 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003895 | 17 Jan 2025 | 759.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0003894 | 3 Nov 2024 | 187.00 | NORTHSTAR MUTUAL | CARC 96 · NON_COVERED | 187.00 |
| CLM0003896 | 5 Oct 2024 | 639.00 | NORTHSTAR MUTUAL | CARC 96 · NON_COVERED | 0.00 |