TOMAS GARCIA
Subscriber on policy B06M000505
Claims
3
Attributed to this person
Charged
1,725.00
Total submitted
Denied
251.00
1 denied claims
Patient responsibility
127.20
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 | TOMAS GARCIA |
| Role on the policy | Subscriber |
| Policy | B06M000505 |
| Date of birth | 26 Jan 1977 |
| Plan | GOLD PPO |
| Covered from | 10 Oct 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 127.20 |
| Total | 127.20 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002254 | 16 Jul 2026 | 838.00 | CASCADE CARE | Not denied | — |
| CLM0002253 | 21 Dec 2025 | 251.00 | CASCADE CARE | CARC 16 · BILLING_ERROR | 251.00 |
| CLM0002255 | 29 Sep 2025 | 636.00 | CASCADE CARE | Not denied | — |