IVAN GARCIA
Dependent on policy B04M000281
Claims
1
Attributed to this person
Charged
310.00
Total submitted
Denied
310.00
1 denied claims
Patient responsibility
0.00
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 GARCIA |
| Role on the policy | Dependent · relationship 01 |
| Policy | B04M000281 |
| Date of birth | 17 Sep 2003 |
| Plan | BRONZE EPO |
| Covered from | 6 Feb 2024 |
| Covered to | 28 May 2024 |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001214 | 1 Jun 2024 | 310.00 | MERIDIAN HEALTH PLAN | CARC 27 · ELIGIBILITY | 310.00 |