ZARA VARGAS
Dependent on policy B04M000628
Claims
2
Attributed to this person
Charged
1,096.00
Total submitted
Denied
0.00
1 denied claims
Patient responsibility
148.85
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 | ZARA VARGAS |
| Role on the policy | Dependent · relationship 19 |
| Policy | B04M000628 |
| Date of birth | 1 Jun 2005 |
| Plan | PLATINUM PPO |
| Covered from | 24 Sep 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 96 · Other | 1 | 148.85 |
| Total | 148.85 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002736 | 19 Aug 2026 | 229.00 | MERIDIAN HEALTH PLAN | CARC 96 · NON_COVERED | 0.00 |
| CLM0002735 | 3 Aug 2025 | 867.00 | MERIDIAN HEALTH PLAN | Not denied | — |