DAVID GARCIA
Dependent on policy B07M000284
Claims
2
Attributed to this person
Charged
575.00
Total submitted
Denied
85.00
1 denied claims
Patient responsibility
73.50
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 | DAVID GARCIA |
| Role on the policy | Dependent · relationship 01 |
| Policy | B07M000284 |
| Date of birth | 6 Mar 2001 |
| Plan | GOLD PPO |
| Covered from | 17 Jun 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 73.50 |
| Total | 73.50 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001234 | 6 Oct 2025 | 490.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0001233 | 18 Sep 2025 | 85.00 | MERIDIAN HEALTH PLAN | CARC 27 · ELIGIBILITY | 85.00 |