ELENA VARGAS
Subscriber on policy B09M000276
Claims
2
Attributed to this person
Charged
932.00
Total submitted
Denied
683.00
1 denied claims
Patient responsibility
37.35
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 | ELENA VARGAS |
| Role on the policy | Subscriber |
| Policy | B09M000276 |
| Date of birth | 9 Dec 1999 |
| Plan | GOLD PPO |
| Covered from | 12 Jun 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 37.35 |
| Total | 37.35 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001137 | 2 Dec 2025 | 683.00 | NORTHSTAR MUTUAL | CARC 197 · AUTHORIZATION | 683.00 |
| CLM0001136 | 18 Jun 2024 | 249.00 | NORTHSTAR MUTUAL | Not denied | — |