VICTOR GARCIA
Subscriber on policy B07M000188
Claims
2
Attributed to this person
Charged
918.00
Total submitted
Denied
339.00
1 denied claims
Patient responsibility
86.85
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 | VICTOR GARCIA |
| Role on the policy | Subscriber |
| Policy | B07M000188 |
| Date of birth | 26 Feb 1956 |
| Plan | SILVER HMO |
| Covered from | 16 Apr 2024 |
| Covered to | 13 Aug 2024 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 86.85 |
| Total | 86.85 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000786 | 12 Aug 2024 | 579.00 | CASCADE CARE | Not denied | — |
| CLM0000785 | 22 May 2024 | 339.00 | CASCADE CARE | CARC 27 · ELIGIBILITY | 339.00 |