OMAR VARGAS
Subscriber on policy B10M000304
Claims
3
Attributed to this person
Charged
1,326.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
76.00
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 | OMAR VARGAS |
| Role on the policy | Subscriber |
| Policy | B10M000304 |
| Date of birth | 10 Aug 1956 |
| Plan | GOLD PPO |
| Covered from | 14 Jul 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 76.00 |
| Total | 76.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001275 | 4 May 2025 | 612.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0001274 | 21 Jun 2024 | 380.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0001273 | 17 Jun 2024 | 334.00 | NORTHSTAR MUTUAL | Not denied | — |