HENRY GARCIA
Dependent on policy B01M000314
Claims
2
Attributed to this person
Charged
705.00
Total submitted
Denied
0.00
1 denied claims
Patient responsibility
195.00
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 | HENRY GARCIA |
| Role on the policy | Dependent · relationship 19 |
| Policy | B01M000314 |
| Date of birth | 12 Jul 1998 |
| Plan | SILVER HMO |
| Covered from | 8 Aug 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 50 · Other | 1 | 195.00 |
| Total | 195.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001398 | 21 Jun 2025 | 405.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0001397 | 20 Nov 2024 | 300.00 | MERIDIAN HEALTH PLAN | CARC 50 · MEDICAL_NECESSITY | 0.00 |