CARLA GARCIA
Dependent on policy B04M000532
Claims
1
Attributed to this person
Charged
333.00
Total submitted
Denied
333.00
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 | CARLA GARCIA |
| Role on the policy | Dependent · relationship 19 |
| Policy | B04M000532 |
| Date of birth | 25 Dec 2020 |
| Plan | SILVER HMO |
| Covered from | 31 Jan 2024 |
| Covered to | 16 Nov 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 |
|---|---|---|---|---|---|
| CLM0002322 | 29 Jan 2024 | 333.00 | MERIDIAN HEALTH PLAN | CARC 26 · ELIGIBILITY | 333.00 |