GRACE GARCIA
Subscriber on policy B08M000748
Claims
2
Attributed to this person
Charged
982.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
140.80
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 | Subscriber |
| Policy | B08M000748 |
| Date of birth | 28 Nov 1958 |
| Plan | BRONZE EPO |
| Covered from | 25 Dec 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 140.80 |
| Total | 140.80 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003347 | 29 Sep 2025 | 278.00 | CASCADE CARE | Not denied | — |
| CLM0003348 | 26 Jan 2025 | 704.00 | CASCADE CARE | Not denied | — |