BRIAN GARCIA
Subscriber on policy B03M000591
Claims
2
Attributed to this person
Charged
1,230.00
Total submitted
Denied
664.00
2 denied claims
Patient responsibility
367.90
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 | BRIAN GARCIA |
| Role on the policy | Subscriber |
| Policy | B03M000591 |
| Date of birth | 12 Oct 1986 |
| Plan | SILVER HMO |
| Covered from | 2 May 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 50 · Other | 1 | 367.90 |
| Total | 367.90 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002417 | 18 Jun 2025 | 566.00 | MERIDIAN HEALTH PLAN | CARC 50 · MEDICAL_NECESSITY | 0.00 |
| CLM0002418 | 7 Jan 2025 | 664.00 | MERIDIAN HEALTH PLAN | CARC 11 · CODING | 664.00 |