TOMAS VARGAS
Dependent on policy B06M000694
Claims
2
Attributed to this person
Charged
1,243.00
Total submitted
Denied
804.20
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 | TOMAS VARGAS |
| Role on the policy | Dependent · relationship 01 |
| Policy | B06M000694 |
| Date of birth | 31 May 1998 |
| Plan | GOLD PPO |
| Covered from | 25 Nov 2024 |
| Covered to | 8 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 |
|---|---|---|---|---|---|
| CLM0003101 | 5 Dec 2024 | 746.00 | CASCADE CARE | CARC 197 · AUTHORIZATION | 307.20 |
| CLM0003102 | 16 Nov 2024 | 497.00 | CASCADE CARE | CARC 27 · ELIGIBILITY | 497.00 |