WENDY GARCIA
Dependent on policy B04M000537
Claims
3
Attributed to this person
Charged
1,849.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
67.80
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 | WENDY GARCIA |
| Role on the policy | Dependent · relationship 01 |
| Policy | B04M000537 |
| Date of birth | 3 Oct 1962 |
| Plan | BRONZE EPO |
| Covered from | 11 Sep 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 67.80 |
| Total | 67.80 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002344 | 11 Oct 2025 | 339.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0002342 | 16 May 2025 | 787.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0002343 | 12 Mar 2025 | 723.00 | NORTHSTAR MUTUAL | Not denied | — |