FIONA GARCIA
Dependent on policy B03M000022
Claims
3
Attributed to this person
Charged
764.00
Total submitted
Denied
341.70
2 denied claims
Patient responsibility
13.65
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 | FIONA GARCIA |
| Role on the policy | Dependent · relationship 01 |
| Policy | B03M000022 |
| Date of birth | 13 May 1980 |
| Plan | GOLD PPO |
| Covered from | 23 Aug 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 13.65 |
| Total | 13.65 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000104 | 6 Feb 2026 | 326.00 | NORTHSTAR MUTUAL | CARC 18 · DUPLICATE | 326.00 |
| CLM0000103 | 20 Dec 2025 | 91.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0000102 | 19 Oct 2025 | 347.00 | NORTHSTAR MUTUAL | CARC 18 · DUPLICATE | 15.70 |