ELENA GARCIA
Dependent on policy B06M000895
Claims
1
Attributed to this person
Charged
399.00
Total submitted
Denied
0.00
0 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 | ELENA GARCIA |
| Role on the policy | Dependent · relationship 01 |
| Policy | B06M000895 |
| Date of birth | 31 Aug 2001 |
| Plan | GOLD PPO |
| Covered from | 28 Sep 2024 |
| Covered to | 1 Feb 2025 |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003897 | 4 Nov 2024 | 399.00 | NORTHSTAR MUTUAL | Not denied | — |