OMAR VARGAS
Dependent on policy B04M000643
Claims
2
Attributed to this person
Charged
1,446.00
Total submitted
Denied
895.00
1 denied claims
Patient responsibility
82.65
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 | OMAR VARGAS |
| Role on the policy | Dependent · relationship 19 |
| Policy | B04M000643 |
| Date of birth | 26 Jun 1998 |
| Plan | BRONZE EPO |
| Covered from | 15 Jan 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 82.65 |
| Total | 82.65 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002798 | 15 May 2026 | 551.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0002799 | 21 Jun 2025 | 895.00 | MERIDIAN HEALTH PLAN | CARC 29 · TIMELY_FILING | 895.00 |