DAVID GARCIA
Subscriber on policy B09M000134
Claims
2
Attributed to this person
Charged
361.00
Total submitted
Denied
182.00
1 denied claims
Patient responsibility
0.00
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 | DAVID GARCIA |
| Role on the policy | Subscriber |
| Policy | B09M000134 |
| Date of birth | 7 Jan 1998 |
| Plan | PLATINUM PPO |
| Covered from | 6 Jun 2024 |
| Covered to | 22 Nov 2024 |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000545 | 2 Jan 2025 | 182.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 182.00 |
| CLM0000546 | 21 Jun 2024 | 179.00 | NORTHSTAR MUTUAL | Not denied | — |