OMAR VARGAS
Dependent on policy B10M000512
Claims
1
Attributed to this person
Charged
404.00
Total submitted
Denied
123.49
1 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 VARGAS |
| Role on the policy | Dependent · relationship 01 |
| Policy | B10M000512 |
| Date of birth | 17 Sep 1970 |
| Plan | PLATINUM PPO |
| Covered from | 27 May 2024 |
| Covered to | 14 Mar 2025 |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002109 | 6 Feb 2025 | 404.00 | CASCADE CARE | CARC 197 · AUTHORIZATION | 123.49 |