UMA GARCIA
Dependent on policy B08M000359
Claims
1
Attributed to this person
Charged
591.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
88.65
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 GARCIA |
| Role on the policy | Dependent · relationship 19 |
| Policy | B08M000359 |
| Date of birth | 29 Jun 2020 |
| Plan | PLATINUM PPO |
| Covered from | 18 Apr 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 88.65 |
| Total | 88.65 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001648 | 31 Jul 2024 | 591.00 | NORTHSTAR MUTUAL | Not denied | — |