TOMAS VARGAS
Dependent on policy B04M000643
Claims
3
Attributed to this person
Charged
1,354.00
Total submitted
Denied
634.00
2 denied claims
Patient responsibility
358.90
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 | Dependent · relationship 01 |
| Policy | B04M000643 |
| Date of birth | 12 Jun 1961 |
| Plan | BRONZE EPO |
| Covered from | 15 Jan 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 50 · Other | 1 | 328.90 |
| CARC 3 · Copay | 1 | 30.00 |
| Total | 358.90 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002794 | 28 May 2026 | 634.00 | MERIDIAN HEALTH PLAN | CARC 197 · AUTHORIZATION | 634.00 |
| CLM0002793 | 23 Jan 2025 | 506.00 | MERIDIAN HEALTH PLAN | CARC 50 · MEDICAL_NECESSITY | 0.00 |
| CLM0002795 | 22 Jan 2025 | 214.00 | MERIDIAN HEALTH PLAN | Not denied | — |