ELENA GARCIA
Dependent on policy B03M000388
Claims
3
Attributed to this person
Charged
1,681.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
120.20
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 | ELENA GARCIA |
| Role on the policy | Dependent · relationship 01 |
| Policy | B03M000388 |
| Date of birth | 9 Apr 1969 |
| Plan | PLATINUM PPO |
| Covered from | 5 Nov 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 120.20 |
| Total | 120.20 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001571 | 9 Aug 2026 | 601.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0001573 | 10 Oct 2025 | 812.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0001572 | 13 Aug 2025 | 268.00 | MERIDIAN HEALTH PLAN | Not denied | — |