HENRY GARCIA
Subscriber on policy B04M000391
Claims
2
Attributed to this person
Charged
578.00
Total submitted
Denied
68.40
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 | HENRY GARCIA |
| Role on the policy | Subscriber |
| Policy | B04M000391 |
| Date of birth | 24 May 2004 |
| Plan | PLATINUM PPO |
| Covered from | 2 Aug 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 |
|---|---|---|---|---|---|
| CLM0001687 | 27 Apr 2026 | 138.00 | NORTHSTAR MUTUAL | CARC 96 · NON_COVERED | 68.40 |
| CLM0001688 | 17 Aug 2024 | 440.00 | NORTHSTAR MUTUAL | Not denied | — |