IVAN GARCIA
Dependent on policy B06M000390
Claims
3
Attributed to this person
Charged
530.00
Total submitted
Denied
308.00
1 denied claims
Patient responsibility
23.60
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 | IVAN GARCIA |
| Role on the policy | Dependent · relationship 01 |
| Policy | B06M000390 |
| Date of birth | 2 Apr 1962 |
| Plan | PLATINUM PPO |
| Covered from | 25 Feb 2025 |
| Covered to | 17 Dec 2025 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 23.60 |
| Total | 23.60 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001771 | 31 Jan 2026 | 118.00 | CASCADE CARE | Not denied | — |
| CLM0001773 | 23 Jan 2026 | 308.00 | CASCADE CARE | CARC 27 · ELIGIBILITY | 308.00 |
| CLM0001772 | 22 Jun 2025 | 104.00 | CASCADE CARE | Not denied | — |