IVAN VARGAS
Dependent on policy B04M000100
Claims
2
Attributed to this person
Charged
1,408.00
Total submitted
Denied
854.00
1 denied claims
Patient responsibility
25.00
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 | IVAN VARGAS |
| Role on the policy | Dependent · relationship 19 |
| Policy | B04M000100 |
| Date of birth | 30 Jul 2011 |
| Plan | GOLD PPO |
| Covered from | 23 Apr 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 3 · Copay | 1 | 25.00 |
| Total | 25.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000461 | 7 Apr 2026 | 554.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0000462 | 31 May 2025 | 854.00 | MERIDIAN HEALTH PLAN | CARC 197 · AUTHORIZATION | 854.00 |