CARLA GARCIA
Dependent on policy B07M000613
Claims
3
Attributed to this person
Charged
2,150.00
Total submitted
Denied
0.00
1 denied claims
Patient responsibility
382.85
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 | CARLA GARCIA |
| Role on the policy | Dependent · relationship 01 |
| Policy | B07M000613 |
| Date of birth | 2 Apr 1964 |
| Plan | GOLD PPO |
| Covered from | 24 Oct 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 96 · Other | 1 | 382.85 |
| Total | 382.85 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002576 | 29 Apr 2026 | 806.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0002578 | 22 Nov 2025 | 589.00 | NORTHSTAR MUTUAL | CARC 96 · NON_COVERED | 0.00 |
| CLM0002577 | 25 Oct 2025 | 755.00 | NORTHSTAR MUTUAL | Not denied | — |