SOFIA GARCIA
Dependent on policy B06M000895
Claims
2
Attributed to this person
Charged
1,167.00
Total submitted
Denied
596.00
2 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 | SOFIA GARCIA |
| Role on the policy | Dependent · relationship 19 |
| Policy | B06M000895 |
| Date of birth | 2 May 2014 |
| 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 |
|---|---|---|---|---|---|
| CLM0003900 | 11 Mar 2025 | 367.00 | NORTHSTAR MUTUAL | CARC 18 · DUPLICATE | 367.00 |
| CLM0003899 | 14 Oct 2024 | 800.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 229.00 |