DAVID GARCIA
Dependent on policy B02M000328
Claims
2
Attributed to this person
Charged
1,116.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
123.45
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 GARCIA |
| Role on the policy | Dependent · relationship 19 |
| Policy | B02M000328 |
| Date of birth | 13 Apr 1992 |
| Plan | PLATINUM PPO |
| Covered from | 9 Feb 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 123.45 |
| Total | 123.45 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001402 | 1 Aug 2025 | 823.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0001401 | 17 Feb 2025 | 293.00 | NORTHSTAR MUTUAL | Not denied | — |