SOFIA GARCIA
Subscriber on policy B09M000427
Claims
3
Attributed to this person
Charged
1,520.00
Total submitted
Denied
676.60
2 denied claims
Patient responsibility
65.85
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 | SOFIA GARCIA |
| Role on the policy | Subscriber |
| Policy | B09M000427 |
| Date of birth | 14 Jun 1950 |
| Plan | GOLD PPO |
| Covered from | 7 Apr 2024 |
| Covered to | 25 Sep 2024 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 65.85 |
| Total | 65.85 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001789 | 21 May 2024 | 746.00 | CASCADE CARE | CARC 29 · TIMELY_FILING | 341.60 |
| CLM0001788 | 16 May 2024 | 439.00 | CASCADE CARE | Not denied | — |
| CLM0001790 | 2 Apr 2024 | 335.00 | CASCADE CARE | CARC 26 · ELIGIBILITY | 335.00 |