JULIA VARGAS
Subscriber on policy B04M000550
Claims
1
Attributed to this person
Charged
680.00
Total submitted
Denied
0.00
1 denied claims
Patient responsibility
442.00
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 | JULIA VARGAS |
| Role on the policy | Subscriber |
| Policy | B04M000550 |
| Date of birth | 6 Feb 1951 |
| Plan | PLATINUM PPO |
| Covered from | 19 Mar 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 96 · Other | 1 | 442.00 |
| Total | 442.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002428 | 17 Oct 2025 | 680.00 | NORTHSTAR MUTUAL | CARC 96 · NON_COVERED | 0.00 |