HENRY GARCIA
Subscriber on policy B06M000215
Claims
2
Attributed to this person
Charged
1,394.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
96.75
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 GARCIA |
| Role on the policy | Subscriber |
| Policy | B06M000215 |
| Date of birth | 5 Jan 1965 |
| Plan | PLATINUM PPO |
| Covered from | 9 Jun 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 96.75 |
| Total | 96.75 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001029 | 24 Mar 2025 | 749.00 | CASCADE CARE | Not denied | — |
| CLM0001030 | 7 Sep 2024 | 645.00 | CASCADE CARE | Not denied | — |