CARLA GARCIA
Dependent on policy B08M000710
Claims
3
Attributed to this person
Charged
2,033.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
114.00
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 | CARLA GARCIA |
| Role on the policy | Dependent · relationship 01 |
| Policy | B08M000710 |
| Date of birth | 17 Jun 1973 |
| Plan | PLATINUM PPO |
| Covered from | 17 Feb 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 114.00 |
| Total | 114.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003188 | 25 Mar 2026 | 760.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0003189 | 17 Oct 2024 | 522.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0003190 | 23 May 2024 | 751.00 | NORTHSTAR MUTUAL | Not denied | — |