BRIAN GARCIA
Subscriber on policy B04M000766
Claims
3
Attributed to this person
Charged
1,495.00
Total submitted
Denied
290.00
1 denied claims
Patient responsibility
51.00
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 | BRIAN GARCIA |
| Role on the policy | Subscriber |
| Policy | B04M000766 |
| Date of birth | 20 Sep 1997 |
| Plan | GOLD PPO |
| Covered from | 21 Sep 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 51.00 |
| Total | 51.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003328 | 12 May 2025 | 865.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0003327 | 11 Apr 2025 | 340.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0003329 | 19 Sep 2024 | 290.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 290.00 |