RAVI GARCIA
Dependent on policy B01M000830
Claims
1
Attributed to this person
Charged
816.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
30.00
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 | Dependent · relationship 19 |
| Policy | B01M000830 |
| Date of birth | 1 Jul 1986 |
| Plan | SILVER HMO |
| Covered from | 16 Feb 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 3 · Copay | 1 | 30.00 |
| Total | 30.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003686 | 23 Sep 2024 | 816.00 | NORTHSTAR MUTUAL | Not denied | — |