DAVID GARCIA
Dependent on policy B09M000078
Claims
1
Attributed to this person
Charged
758.00
Total submitted
Denied
758.00
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 | Dependent · relationship 01 |
| Policy | B09M000078 |
| Date of birth | 14 Apr 1999 |
| Plan | GOLD PPO |
| Covered from | 8 Jan 2024 |
| Covered to | open |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000341 | 17 Apr 2024 | 758.00 | CASCADE CARE | CARC 16 · BILLING_ERROR | 758.00 |