UMA VARGAS
Dependent on policy B10M000725
Claims
2
Attributed to this person
Charged
899.00
Total submitted
Denied
495.00
1 denied claims
Patient responsibility
60.60
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 | UMA VARGAS |
| Role on the policy | Dependent · relationship 19 |
| Policy | B10M000725 |
| Date of birth | 8 Jul 2002 |
| Plan | PLATINUM PPO |
| Covered from | 11 Jan 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 60.60 |
| Total | 60.60 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003046 | 14 Jun 2024 | 404.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0003045 | 3 Mar 2024 | 495.00 | MERIDIAN HEALTH PLAN | CARC 27 · ELIGIBILITY | 495.00 |