PRIYA GARCIA
Dependent on policy B02M000410
Claims
1
Attributed to this person
Charged
665.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
99.75
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 | PRIYA GARCIA |
| Role on the policy | Dependent · relationship 01 |
| Policy | B02M000410 |
| Date of birth | 6 Jun 1962 |
| Plan | GOLD PPO |
| Covered from | 28 Mar 2025 |
| Covered to | 5 Nov 2025 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 99.75 |
| Total | 99.75 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001765 | 5 Nov 2025 | 665.00 | NORTHSTAR MUTUAL | Not denied | — |