UMA GARCIA
Subscriber on policy B08M000529
Claims
2
Attributed to this person
Charged
1,228.00
Total submitted
Denied
0.00
1 denied claims
Patient responsibility
504.40
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 | Subscriber |
| Policy | B08M000529 |
| Date of birth | 12 May 1971 |
| Plan | SILVER HMO |
| Covered from | 2 Jan 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 96 · Other | 1 | 504.40 |
| Total | 504.40 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002420 | 17 May 2026 | 776.00 | NORTHSTAR MUTUAL | CARC 96 · NON_COVERED | 0.00 |
| CLM0002419 | 10 Feb 2025 | 452.00 | NORTHSTAR MUTUAL | Not denied | — |