RAVI VARGAS
Subscriber on policy B04M000765
Claims
1
Attributed to this person
Charged
332.00
Total submitted
Denied
0.00
1 denied claims
Patient responsibility
215.80
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 | RAVI VARGAS |
| Role on the policy | Subscriber |
| Policy | B04M000765 |
| Date of birth | 28 Mar 1966 |
| Plan | GOLD PPO |
| Covered from | 25 Nov 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 50 · Other | 1 | 215.80 |
| Total | 215.80 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003325 | 30 Oct 2024 | 332.00 | MERIDIAN HEALTH PLAN | CARC 50 · MEDICAL_NECESSITY | 0.00 |