LEILA VARGAS
Dependent on policy B03M000192
Claims
3
Attributed to this person
Charged
1,126.00
Total submitted
Denied
373.00
1 denied claims
Patient responsibility
0.00
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 VARGAS |
| Role on the policy | Dependent · relationship 19 |
| Policy | B03M000192 |
| Date of birth | 4 Jun 1980 |
| Plan | SILVER HMO |
| Covered from | 9 Mar 2024 |
| Covered to | 10 Sep 2024 |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000786 | 10 Oct 2024 | 460.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0000787 | 3 Sep 2024 | 293.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0000788 | 30 Apr 2024 | 373.00 | NORTHSTAR MUTUAL | CARC 11 · CODING | 373.00 |