AMARA VARGAS
Dependent on policy B03M000193
Claims
1
Attributed to this person
Charged
155.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
31.00
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 | AMARA VARGAS |
| Role on the policy | Dependent · relationship 19 |
| Policy | B03M000193 |
| Date of birth | 22 Jan 2008 |
| Plan | SILVER HMO |
| Covered from | 20 Jun 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 31.00 |
| Total | 31.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000797 | 21 Nov 2024 | 155.00 | NORTHSTAR MUTUAL | Not denied | — |