WENDY VARGAS
Dependent on policy B07M000703
Claims
2
Attributed to this person
Charged
987.00
Total submitted
Denied
0.00
1 denied claims
Patient responsibility
425.75
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 | WENDY VARGAS |
| Role on the policy | Dependent · relationship 01 |
| Policy | B07M000703 |
| Date of birth | 21 Mar 1948 |
| Plan | GOLD PPO |
| Covered from | 16 Sep 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 50 · Other | 1 | 425.75 |
| Total | 425.75 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002910 | 15 May 2025 | 332.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0002909 | 12 Apr 2025 | 655.00 | MERIDIAN HEALTH PLAN | CARC 50 · MEDICAL_NECESSITY | 0.00 |