LEILA GARCIA
Dependent on policy B03M000842
Claims
3
Attributed to this person
Charged
1,378.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
20.00
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 | LEILA GARCIA |
| Role on the policy | Dependent · relationship 19 |
| Policy | B03M000842 |
| Date of birth | 23 Jun 2009 |
| Plan | GOLD PPO |
| Covered from | 11 Mar 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 3 · Copay | 1 | 20.00 |
| Total | 20.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003635 | 11 Jul 2026 | 474.00 | CASCADE CARE | Not denied | — |
| CLM0003637 | 8 Jun 2025 | 839.00 | CASCADE CARE | Not denied | — |
| CLM0003636 | 13 Sep 2024 | 65.00 | CASCADE CARE | Not denied | — |