OMAR GARCIA
Dependent on policy B10M000341
Claims
3
Attributed to this person
Charged
1,723.00
Total submitted
Denied
801.03
2 denied claims
Patient responsibility
0.00
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 GARCIA |
| Role on the policy | Dependent · relationship 19 |
| Policy | B10M000341 |
| Date of birth | 24 Jan 2017 |
| Plan | PLATINUM PPO |
| Covered from | 7 Jan 2025 |
| Covered to | open |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001428 | 4 Nov 2025 | 509.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0001427 | 21 Jul 2025 | 614.00 | NORTHSTAR MUTUAL | CARC 197 · AUTHORIZATION | 614.00 |
| CLM0001426 | 24 Jun 2025 | 600.00 | NORTHSTAR MUTUAL | CARC 109 · COB | 187.03 |