TOMAS VARGAS
Dependent on policy B04M000682
Claims
2
Attributed to this person
Charged
1,043.00
Total submitted
Denied
425.00
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 | TOMAS VARGAS |
| Role on the policy | Dependent · relationship 01 |
| Policy | B04M000682 |
| Date of birth | 2 May 2001 |
| Plan | PLATINUM PPO |
| Covered from | 14 Sep 2024 |
| Covered to | 20 Jan 2025 |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002976 | 2 Jan 2025 | 618.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0002975 | 30 Nov 2024 | 425.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 425.00 |