GRACE VARGAS
Dependent on policy B09M000128
Claims
3
Attributed to this person
Charged
2,217.00
Total submitted
Denied
843.00
1 denied claims
Patient responsibility
160.80
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 VARGAS |
| Role on the policy | Dependent · relationship 01 |
| Policy | B09M000128 |
| Date of birth | 2 Apr 2005 |
| Plan | PLATINUM PPO |
| Covered from | 19 Aug 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 160.80 |
| Total | 160.80 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000529 | 27 Mar 2026 | 843.00 | MERIDIAN HEALTH PLAN | CARC 109 · COB | 843.00 |
| CLM0000530 | 27 Aug 2025 | 570.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0000531 | 10 Aug 2025 | 804.00 | MERIDIAN HEALTH PLAN | Not denied | — |