CARLA VARGAS
Subscriber on policy B09M000366
Claims
3
Attributed to this person
Charged
1,712.00
Total submitted
Denied
459.00
2 denied claims
Patient responsibility
449.15
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 | CARLA VARGAS |
| Role on the policy | Subscriber |
| Policy | B09M000366 |
| Date of birth | 25 May 1997 |
| Plan | SILVER HMO |
| Covered from | 30 Jan 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 96 · Other | 1 | 449.15 |
| Total | 449.15 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001510 | 2 Feb 2026 | 691.00 | CASCADE CARE | CARC 96 · NON_COVERED | 0.00 |
| CLM0001511 | 21 Sep 2025 | 562.00 | CASCADE CARE | Not denied | — |
| CLM0001512 | 28 Jun 2024 | 459.00 | CASCADE CARE | CARC 18 · DUPLICATE | 459.00 |