TOMAS VARGAS
Subscriber on policy B04M000399
Claims
2
Attributed to this person
Charged
1,210.00
Total submitted
Denied
657.00
1 denied claims
Patient responsibility
50.00
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 | TOMAS VARGAS |
| Role on the policy | Subscriber |
| Policy | B04M000399 |
| Date of birth | 3 Dec 1967 |
| Plan | BRONZE EPO |
| Covered from | 23 Feb 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 3 · Copay | 1 | 50.00 |
| Total | 50.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001713 | 16 Feb 2026 | 553.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0001714 | 13 Feb 2025 | 657.00 | MERIDIAN HEALTH PLAN | CARC 26 · ELIGIBILITY | 657.00 |