CARLA VARGAS
Dependent on policy B03M000457
Claims
2
Attributed to this person
Charged
952.00
Total submitted
Denied
854.00
1 denied claims
Patient responsibility
19.60
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 | CARLA VARGAS |
| Role on the policy | Dependent · relationship 19 |
| Policy | B03M000457 |
| Date of birth | 4 Oct 2012 |
| Plan | GOLD PPO |
| Covered from | 15 Oct 2024 |
| Covered to | 24 Feb 2025 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 19.60 |
| Total | 19.60 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001893 | 11 Mar 2025 | 854.00 | MERIDIAN HEALTH PLAN | CARC 27 · ELIGIBILITY | 854.00 |
| CLM0001892 | 28 Sep 2024 | 98.00 | MERIDIAN HEALTH PLAN | Not denied | — |