IVAN GARCIA
Dependent on policy B03M000801
Claims
3
Attributed to this person
Charged
993.00
Total submitted
Denied
115.00
1 denied claims
Patient responsibility
115.65
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 | IVAN GARCIA |
| Role on the policy | Dependent · relationship 19 |
| Policy | B03M000801 |
| Date of birth | 23 Sep 1975 |
| Plan | GOLD PPO |
| Covered from | 10 Nov 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 115.65 |
| Total | 115.65 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003436 | 17 Feb 2026 | 115.00 | MERIDIAN HEALTH PLAN | CARC 29 · TIMELY_FILING | 115.00 |
| CLM0003437 | 17 Feb 2026 | 771.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0003438 | 26 May 2025 | 107.00 | MERIDIAN HEALTH PLAN | Not denied | — |