JULIA VARGAS
Dependent on policy B10M000877
Claims
3
Attributed to this person
Charged
1,659.00
Total submitted
Denied
956.00
2 denied claims
Patient responsibility
140.60
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 | JULIA VARGAS |
| Role on the policy | Dependent · relationship 19 |
| Policy | B10M000877 |
| Date of birth | 11 Nov 2023 |
| Plan | BRONZE EPO |
| Covered from | 2 Apr 2024 |
| Covered to | 13 Jun 2024 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 140.60 |
| Total | 140.60 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003727 | 28 Jul 2024 | 546.00 | CASCADE CARE | CARC 27 · ELIGIBILITY | 546.00 |
| CLM0003729 | 25 Jul 2024 | 703.00 | CASCADE CARE | Not denied | — |
| CLM0003728 | 18 Jul 2024 | 410.00 | CASCADE CARE | CARC 27 · ELIGIBILITY | 410.00 |