GRACE GARCIA
Subscriber on policy B03M000539
Claims
2
Attributed to this person
Charged
1,461.00
Total submitted
Denied
881.00
1 denied claims
Patient responsibility
0.00
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 | GRACE GARCIA |
| Role on the policy | Subscriber |
| Policy | B03M000539 |
| Date of birth | 25 Aug 1982 |
| Plan | GOLD PPO |
| Covered from | 12 Aug 2024 |
| Covered to | 11 Mar 2025 |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002218 | 25 Oct 2024 | 580.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0002217 | 29 Jul 2024 | 881.00 | MERIDIAN HEALTH PLAN | CARC 18 · DUPLICATE | 881.00 |