FIONA GARCIA
Subscriber on policy B01M000297
Claims
3
Attributed to this person
Charged
1,042.00
Total submitted
Denied
143.61
1 denied claims
Patient responsibility
17.70
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 | FIONA GARCIA |
| Role on the policy | Subscriber |
| Policy | B01M000297 |
| Date of birth | 2 May 1954 |
| Plan | BRONZE EPO |
| Covered from | 5 May 2024 |
| Covered to | 10 Oct 2024 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 17.70 |
| Total | 17.70 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001304 | 1 Nov 2024 | 118.00 | CASCADE CARE | Not denied | — |
| CLM0001305 | 9 Oct 2024 | 634.00 | CASCADE CARE | Not denied | — |
| CLM0001306 | 28 Jun 2024 | 290.00 | CASCADE CARE | CARC 27 · ELIGIBILITY | 143.61 |