VICTOR GARCIA
Dependent on policy B02M000397
Claims
3
Attributed to this person
Charged
1,137.00
Total submitted
Denied
102.33
1 denied claims
Patient responsibility
50.00
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 | VICTOR GARCIA |
| Role on the policy | Dependent · relationship 01 |
| Policy | B02M000397 |
| Date of birth | 17 Sep 1983 |
| Plan | BRONZE EPO |
| Covered from | 31 Oct 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 3 · Copay | 1 | 50.00 |
| Total | 50.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001705 | 11 Jun 2025 | 472.00 | CASCADE CARE | CARC 16 · BILLING_ERROR | 102.33 |
| CLM0001704 | 16 Apr 2025 | 79.00 | CASCADE CARE | Not denied | — |
| CLM0001703 | 21 Mar 2025 | 586.00 | CASCADE CARE | Not denied | — |