PRIYA GARCIA
Dependent on policy B07M000613
Claims
3
Attributed to this person
Charged
2,020.00
Total submitted
Denied
885.00
1 denied claims
Patient responsibility
62.80
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 | PRIYA GARCIA |
| Role on the policy | Dependent · relationship 19 |
| Policy | B07M000613 |
| Date of birth | 16 Dec 1993 |
| Plan | GOLD PPO |
| Covered from | 24 Oct 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 62.80 |
| Total | 62.80 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002579 | 2 Apr 2026 | 821.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0002580 | 16 Jun 2025 | 885.00 | NORTHSTAR MUTUAL | CARC 29 · TIMELY_FILING | 885.00 |
| CLM0002581 | 22 Feb 2025 | 314.00 | NORTHSTAR MUTUAL | Not denied | — |