DAVID VARGAS
Subscriber on policy B03M000580
Claims
2
Attributed to this person
Charged
360.00
Total submitted
Denied
169.00
1 denied claims
Patient responsibility
38.20
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 | DAVID VARGAS |
| Role on the policy | Subscriber |
| Policy | B03M000580 |
| Date of birth | 18 Jul 1964 |
| Plan | BRONZE EPO |
| Covered from | 5 May 2025 |
| Covered to | 21 Jan 2026 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 38.20 |
| Total | 38.20 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002360 | 16 Nov 2025 | 169.00 | CASCADE CARE | CARC 197 · AUTHORIZATION | 169.00 |
| CLM0002359 | 9 Aug 2025 | 191.00 | CASCADE CARE | Not denied | — |