UMA VARGAS
Dependent on policy B01M000058
Claims
3
Attributed to this person
Charged
1,391.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
166.60
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 | UMA VARGAS |
| Role on the policy | Dependent · relationship 19 |
| Policy | B01M000058 |
| Date of birth | 13 Nov 1997 |
| Plan | BRONZE EPO |
| Covered from | 18 Jun 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 166.60 |
| Total | 166.60 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000250 | 3 Aug 2026 | 235.00 | CASCADE CARE | Not denied | — |
| CLM0000252 | 3 May 2026 | 323.00 | CASCADE CARE | Not denied | — |
| CLM0000251 | 13 Jul 2025 | 833.00 | CASCADE CARE | Not denied | — |