BRIAN VARGAS
Dependent on policy B01M000678
Claims
3
Attributed to this person
Charged
1,361.00
Total submitted
Denied
0.00
1 denied claims
Patient responsibility
128.70
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 | BRIAN VARGAS |
| Role on the policy | Dependent · relationship 19 |
| Policy | B01M000678 |
| Date of birth | 4 Aug 1999 |
| Plan | PLATINUM PPO |
| Covered from | 19 May 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 50 · Other | 1 | 128.70 |
| Total | 128.70 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003038 | 18 May 2026 | 848.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0003039 | 11 Jan 2026 | 198.00 | NORTHSTAR MUTUAL | CARC 50 · MEDICAL_NECESSITY | 0.00 |
| CLM0003040 | 22 Nov 2025 | 315.00 | NORTHSTAR MUTUAL | Not denied | — |