TOMAS GARCIA
Subscriber on policy B03M000344
Claims
1
Attributed to this person
Charged
573.00
Total submitted
Denied
573.00
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 | TOMAS GARCIA |
| Role on the policy | Subscriber |
| Policy | B03M000344 |
| Date of birth | 16 Apr 1999 |
| Plan | PLATINUM PPO |
| Covered from | 23 Nov 2024 |
| Covered to | 15 Aug 2025 |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001392 | 10 Mar 2025 | 573.00 | CASCADE CARE | CARC 27 · ELIGIBILITY | 573.00 |