DAVID VARGAS
Subscriber on policy B02M000576
Claims
3
Attributed to this person
Charged
2,295.00
Total submitted
Denied
727.00
2 denied claims
Patient responsibility
471.25
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 | Subscriber |
| Policy | B02M000576 |
| Date of birth | 28 May 2000 |
| Plan | GOLD PPO |
| Covered from | 28 Nov 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 96 · Other | 1 | 471.25 |
| Total | 471.25 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002414 | 4 Jun 2026 | 727.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 727.00 |
| CLM0002412 | 17 Jul 2025 | 725.00 | NORTHSTAR MUTUAL | CARC 96 · NON_COVERED | 0.00 |
| CLM0002413 | 17 May 2025 | 843.00 | NORTHSTAR MUTUAL | Not denied | — |