CARLA VARGAS
Dependent on policy B04M000146
Claims
2
Attributed to this person
Charged
490.00
Total submitted
Denied
394.00
1 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 | CARLA VARGAS |
| Role on the policy | Dependent · relationship 19 |
| Policy | B04M000146 |
| Date of birth | 29 Jun 2005 |
| Plan | PLATINUM PPO |
| Covered from | 6 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 |
|---|---|---|---|---|---|
| CLM0000677 | 13 Sep 2025 | 394.00 | NORTHSTAR MUTUAL | CARC 197 · AUTHORIZATION | 394.00 |
| CLM0000676 | 4 Jun 2025 | 96.00 | NORTHSTAR MUTUAL | Not denied | — |