TOMAS GARCIA
Dependent on policy B03M000830
Claims
2
Attributed to this person
Charged
1,245.00
Total submitted
Denied
778.00
1 denied claims
Patient responsibility
93.40
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 | TOMAS GARCIA |
| Role on the policy | Dependent · relationship 19 |
| Policy | B03M000830 |
| Date of birth | 27 Oct 1996 |
| Plan | PLATINUM PPO |
| Covered from | 9 Jan 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 93.40 |
| Total | 93.40 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003582 | 3 Dec 2025 | 467.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0003583 | 21 Nov 2025 | 778.00 | MERIDIAN HEALTH PLAN | CARC 27 · ELIGIBILITY | 778.00 |