AMARA GARCIA
Dependent on policy B02M000818
Claims
3
Attributed to this person
Charged
1,636.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
89.30
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 | AMARA GARCIA |
| Role on the policy | Dependent · relationship 01 |
| Policy | B02M000818 |
| Date of birth | 6 May 1979 |
| Plan | GOLD PPO |
| Covered from | 8 Mar 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 69.30 |
| CARC 3 · Copay | 1 | 20.00 |
| Total | 89.30 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003397 | 11 Jul 2025 | 770.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0003399 | 9 Apr 2025 | 462.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0003398 | 6 Mar 2025 | 404.00 | NORTHSTAR MUTUAL | Not denied | — |