ZARA VARGAS
Subscriber on policy B07M000128
Claims
2
Attributed to this person
Charged
1,058.00
Total submitted
Denied
401.00
1 denied claims
Patient responsibility
98.55
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 | ZARA VARGAS |
| Role on the policy | Subscriber |
| Policy | B07M000128 |
| Date of birth | 1 Jul 1966 |
| Plan | GOLD PPO |
| Covered from | 4 Aug 2024 |
| Covered to | 30 Nov 2024 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 98.55 |
| Total | 98.55 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000531 | 19 Jan 2025 | 401.00 | MERIDIAN HEALTH PLAN | CARC 27 · ELIGIBILITY | 401.00 |
| CLM0000532 | 14 Aug 2024 | 657.00 | MERIDIAN HEALTH PLAN | Not denied | — |