RAVI GARCIA
Subscriber on policy B03M000243
Claims
1
Attributed to this person
Charged
424.00
Total submitted
Denied
424.00
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 | RAVI GARCIA |
| Role on the policy | Subscriber |
| Policy | B03M000243 |
| Date of birth | 1 Feb 1965 |
| Plan | PLATINUM PPO |
| Covered from | 30 May 2025 |
| Covered to | 2 Jan 2026 |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000989 | 3 Sep 2025 | 424.00 | NORTHSTAR MUTUAL | CARC 197 · AUTHORIZATION | 424.00 |