HENRY VARGAS
Dependent on policy B02M000576
Claims
1
Attributed to this person
Charged
704.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
140.80
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 | HENRY VARGAS |
| Role on the policy | Dependent · relationship 19 |
| Policy | B02M000576 |
| Date of birth | 3 Oct 2009 |
| Plan | GOLD PPO |
| Covered from | 28 Nov 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 140.80 |
| Total | 140.80 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002421 | 15 May 2025 | 704.00 | NORTHSTAR MUTUAL | Not denied | — |