GRACE VARGAS
Subscriber on policy B02M000399
Claims
2
Attributed to this person
Charged
829.00
Total submitted
Denied
307.60
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 | GRACE VARGAS |
| Role on the policy | Subscriber |
| Policy | B02M000399 |
| Date of birth | 4 Oct 2001 |
| Plan | SILVER HMO |
| Covered from | 24 Feb 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 |
|---|---|---|---|---|---|
| CLM0001714 | 4 Jan 2025 | 182.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0001715 | 16 Aug 2024 | 647.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 307.60 |