GRACE GARCIA
Dependent on policy B01M000132
Claims
2
Attributed to this person
Charged
481.00
Total submitted
Denied
128.00
1 denied claims
Patient responsibility
52.95
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 | GRACE GARCIA |
| Role on the policy | Dependent · relationship 19 |
| Policy | B01M000132 |
| Date of birth | 26 Aug 1995 |
| Plan | PLATINUM PPO |
| Covered from | 8 Dec 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 52.95 |
| Total | 52.95 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000539 | 20 Dec 2025 | 128.00 | CASCADE CARE | CARC 16 · BILLING_ERROR | 128.00 |
| CLM0000540 | 14 May 2025 | 353.00 | CASCADE CARE | Not denied | — |