OMAR GARCIA
Dependent on policy B10M000138
Claims
1
Attributed to this person
Charged
677.00
Total submitted
Denied
0.00
1 denied claims
Patient responsibility
440.05
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 | OMAR GARCIA |
| Role on the policy | Dependent · relationship 19 |
| Policy | B10M000138 |
| Date of birth | 21 Jan 2004 |
| Plan | PLATINUM PPO |
| Covered from | 23 Feb 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 50 · Other | 1 | 440.05 |
| Total | 440.05 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000579 | 28 Dec 2025 | 677.00 | MERIDIAN HEALTH PLAN | CARC 50 · MEDICAL_NECESSITY | 0.00 |