ELENA VARGAS
Subscriber on policy B04M000651
Claims
3
Attributed to this person
Charged
1,861.00
Total submitted
Denied
1,052.00
3 denied claims
Patient responsibility
525.85
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 | ELENA VARGAS |
| Role on the policy | Subscriber |
| Policy | B04M000651 |
| Date of birth | 14 Nov 2003 |
| Plan | PLATINUM PPO |
| Covered from | 3 Jan 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 96 · Other | 1 | 525.85 |
| Total | 525.85 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002836 | 12 Jun 2026 | 809.00 | MERIDIAN HEALTH PLAN | CARC 96 · NON_COVERED | 0.00 |
| CLM0002835 | 20 May 2024 | 243.00 | MERIDIAN HEALTH PLAN | CARC 29 · TIMELY_FILING | 243.00 |
| CLM0002837 | 10 Mar 2024 | 809.00 | MERIDIAN HEALTH PLAN | CARC 11 · CODING | 809.00 |