UMA VARGAS
Subscriber on policy B02M000135
Claims
3
Attributed to this person
Charged
1,021.00
Total submitted
Denied
102.00
1 denied claims
Patient responsibility
103.80
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 | UMA VARGAS |
| Role on the policy | Subscriber |
| Policy | B02M000135 |
| Date of birth | 19 Dec 2000 |
| Plan | SILVER HMO |
| Covered from | 27 Feb 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 103.80 |
| Total | 103.80 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000612 | 17 Aug 2026 | 400.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0000613 | 4 Jun 2025 | 102.00 | NORTHSTAR MUTUAL | CARC 11 · CODING | 102.00 |
| CLM0000611 | 20 May 2025 | 519.00 | NORTHSTAR MUTUAL | Not denied | — |