LEILA GARCIA
Dependent on policy B03M000801
Claims
3
Attributed to this person
Charged
1,451.00
Total submitted
Denied
523.06
2 denied claims
Patient responsibility
25.00
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 | LEILA GARCIA |
| Role on the policy | Dependent · relationship 19 |
| Policy | B03M000801 |
| Date of birth | 29 Oct 1989 |
| Plan | GOLD PPO |
| Covered from | 10 Nov 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 3 · Copay | 1 | 25.00 |
| Total | 25.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003435 | 5 Feb 2026 | 397.00 | MERIDIAN HEALTH PLAN | CARC 16 · BILLING_ERROR | 397.00 |
| CLM0003433 | 25 Feb 2025 | 316.00 | MERIDIAN HEALTH PLAN | CARC 11 · CODING | 126.06 |
| CLM0003434 | 1 Dec 2024 | 738.00 | MERIDIAN HEALTH PLAN | Not denied | — |