CARLA VARGAS
Subscriber on policy B04M000800
Claims
3
Attributed to this person
Charged
1,009.00
Total submitted
Denied
299.00
2 denied claims
Patient responsibility
156.65
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 | CARLA VARGAS |
| Role on the policy | Subscriber |
| Policy | B04M000800 |
| Date of birth | 15 Apr 1968 |
| Plan | PLATINUM PPO |
| Covered from | 22 Feb 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 96 · Other | 1 | 156.65 |
| Total | 156.65 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003498 | 5 Feb 2026 | 241.00 | MERIDIAN HEALTH PLAN | CARC 96 · NON_COVERED | 0.00 |
| CLM0003497 | 31 Oct 2025 | 299.00 | MERIDIAN HEALTH PLAN | CARC 29 · TIMELY_FILING | 299.00 |
| CLM0003496 | 31 Aug 2025 | 469.00 | MERIDIAN HEALTH PLAN | Not denied | — |