WENDY VARGAS
Subscriber on policy B10M000877
Claims
3
Attributed to this person
Charged
1,574.00
Total submitted
Denied
415.00
1 denied claims
Patient responsibility
55.50
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 | WENDY VARGAS |
| Role on the policy | Subscriber |
| Policy | B10M000877 |
| Date of birth | 1 Apr 1992 |
| Plan | BRONZE EPO |
| Covered from | 2 Apr 2024 |
| Covered to | 13 Jun 2024 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 55.50 |
| Total | 55.50 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003722 | 26 Jul 2024 | 415.00 | CASCADE CARE | CARC 27 · ELIGIBILITY | 415.00 |
| CLM0003721 | 22 Apr 2024 | 370.00 | CASCADE CARE | Not denied | — |
| CLM0003723 | 9 Apr 2024 | 789.00 | CASCADE CARE | Not denied | — |