VICTOR GARCIA
Dependent on policy B07M000001
Claims
3
Attributed to this person
Charged
821.00
Total submitted
Denied
502.00
2 denied claims
Patient responsibility
165.10
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 | VICTOR GARCIA |
| Role on the policy | Dependent · relationship 01 |
| Policy | B07M000001 |
| Date of birth | 4 May 1966 |
| Plan | GOLD PPO |
| Covered from | 3 Feb 2024 |
| Covered to | 1 Nov 2024 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 96 · Other | 1 | 165.10 |
| Total | 165.10 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000007 | 25 Sep 2024 | 65.00 | CASCADE CARE | Not denied | — |
| CLM0000008 | 1 Sep 2024 | 254.00 | CASCADE CARE | CARC 96 · NON_COVERED | 0.00 |
| CLM0000009 | 26 Jan 2024 | 502.00 | CASCADE CARE | CARC 26 · ELIGIBILITY | 502.00 |