SOFIA GARCIA
Subscriber on policy B04M000053
Claims
3
Attributed to this person
Charged
1,712.00
Total submitted
Denied
1,152.00
2 denied claims
Patient responsibility
84.00
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 | SOFIA GARCIA |
| Role on the policy | Subscriber |
| Policy | B04M000053 |
| Date of birth | 2 Jan 1954 |
| Plan | GOLD PPO |
| Covered from | 21 Jun 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 84.00 |
| Total | 84.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000243 | 9 Mar 2026 | 835.00 | MERIDIAN HEALTH PLAN | CARC 18 · DUPLICATE | 835.00 |
| CLM0000244 | 6 Jan 2026 | 560.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0000245 | 1 Jun 2025 | 317.00 | MERIDIAN HEALTH PLAN | CARC 26 · ELIGIBILITY | 317.00 |