VICTOR VARGAS
Subscriber on policy B04M000321
Claims
2
Attributed to this person
Charged
708.00
Total submitted
Denied
594.00
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 | VICTOR VARGAS |
| Role on the policy | Subscriber |
| Policy | B04M000321 |
| Date of birth | 28 Sep 1955 |
| Plan | SILVER HMO |
| Covered from | 11 Feb 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 |
|---|---|---|---|---|---|
| CLM0001402 | 2 Aug 2024 | 114.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0001401 | 19 Jan 2024 | 594.00 | NORTHSTAR MUTUAL | CARC 26 · ELIGIBILITY | 594.00 |