WENDY VARGAS
Subscriber on policy B03M000810
Claims
2
Attributed to this person
Charged
637.00
Total submitted
Denied
492.00
1 denied claims
Patient responsibility
21.75
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 | WENDY VARGAS |
| Role on the policy | Subscriber |
| Policy | B03M000810 |
| Date of birth | 28 May 2003 |
| Plan | SILVER HMO |
| Covered from | 19 Mar 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 21.75 |
| Total | 21.75 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003484 | 8 Jun 2025 | 145.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0003485 | 9 Jul 2024 | 492.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 492.00 |