GRACE GARCIA
Subscriber on policy B02M000556
Claims
1
Attributed to this person
Charged
541.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
81.15
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 | GRACE GARCIA |
| Role on the policy | Subscriber |
| Policy | B02M000556 |
| Date of birth | 30 Aug 1968 |
| Plan | PLATINUM PPO |
| Covered from | 15 Apr 2025 |
| Covered to | 9 Jul 2025 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 81.15 |
| Total | 81.15 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002350 | 17 Jun 2025 | 541.00 | CASCADE CARE | Not denied | — |