DAVID VARGAS
Dependent on policy B02M000196
Claims
3
Attributed to this person
Charged
1,107.00
Total submitted
Denied
171.00
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 | DAVID VARGAS |
| Role on the policy | Dependent · relationship 19 |
| Policy | B02M000196 |
| Date of birth | 17 Sep 1991 |
| Plan | GOLD PPO |
| Covered from | 14 Mar 2024 |
| Covered to | open |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000864 | 16 Jan 2026 | 171.00 | NORTHSTAR MUTUAL | CARC 50 · MEDICAL_NECESSITY | 171.00 |
| CLM0000865 | 27 Apr 2025 | 605.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0000863 | 11 Jun 2024 | 331.00 | NORTHSTAR MUTUAL | Not denied | — |