LEILA GARCIA
Dependent on policy B10M000341
Claims
2
Attributed to this person
Charged
1,168.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
51.45
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 | LEILA GARCIA |
| Role on the policy | Dependent · relationship 01 |
| Policy | B10M000341 |
| Date of birth | 19 Feb 1997 |
| Plan | PLATINUM PPO |
| Covered from | 7 Jan 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 51.45 |
| Total | 51.45 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001425 | 6 Jun 2026 | 825.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0001424 | 9 Mar 2026 | 343.00 | NORTHSTAR MUTUAL | Not denied | — |