OMAR GARCIA
Dependent on policy B04M000876
Claims
2
Attributed to this person
Charged
557.00
Total submitted
Denied
557.00
2 denied claims
Patient responsibility
0.00
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 GARCIA |
| Role on the policy | Dependent · relationship 19 |
| Policy | B04M000876 |
| Date of birth | 25 Nov 1994 |
| Plan | BRONZE EPO |
| Covered from | 18 Jul 2024 |
| Covered to | open |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003791 | 19 Dec 2025 | 248.00 | MERIDIAN HEALTH PLAN | CARC 29 · TIMELY_FILING | 248.00 |
| CLM0003792 | 11 Jun 2025 | 309.00 | MERIDIAN HEALTH PLAN | CARC 18 · DUPLICATE | 309.00 |