FIONA GARCIA
Subscriber on policy B04M000795
Claims
3
Attributed to this person
Charged
1,690.00
Total submitted
Denied
1,058.58
2 denied claims
Patient responsibility
55.95
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 | FIONA GARCIA |
| Role on the policy | Subscriber |
| Policy | B04M000795 |
| Date of birth | 10 Jan 1994 |
| Plan | SILVER HMO |
| Covered from | 1 Feb 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 55.95 |
| Total | 55.95 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003470 | 2 Jan 2026 | 441.00 | NORTHSTAR MUTUAL | CARC 18 · DUPLICATE | 182.58 |
| CLM0003471 | 17 May 2025 | 373.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0003469 | 11 May 2025 | 876.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 876.00 |