WENDY VARGAS
Dependent on policy B01M000772
Claims
2
Attributed to this person
Charged
1,235.00
Total submitted
Denied
237.38
2 denied claims
Patient responsibility
490.10
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 | Dependent · relationship 01 |
| Policy | B01M000772 |
| Date of birth | 30 Jan 1972 |
| Plan | GOLD PPO |
| Covered from | 11 May 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 96 · Other | 1 | 490.10 |
| Total | 490.10 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003433 | 25 May 2026 | 481.00 | MERIDIAN HEALTH PLAN | CARC 197 · AUTHORIZATION | 237.38 |
| CLM0003432 | 20 May 2026 | 754.00 | MERIDIAN HEALTH PLAN | CARC 96 · NON_COVERED | 0.00 |