RAVI GARCIA
Subscriber on policy B01M000760
Claims
3
Attributed to this person
Charged
1,551.00
Total submitted
Denied
855.00
1 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 | RAVI GARCIA |
| Role on the policy | Subscriber |
| Policy | B01M000760 |
| Date of birth | 11 Jun 1999 |
| Plan | GOLD PPO |
| Covered from | 3 May 2024 |
| Covered to | 5 Aug 2024 |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003384 | 4 Aug 2024 | 129.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0003385 | 25 Jul 2024 | 567.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0003386 | 17 Apr 2024 | 855.00 | NORTHSTAR MUTUAL | CARC 26 · ELIGIBILITY | 855.00 |