ELENA GARCIA
Subscriber on policy B04M000032
Claims
2
Attributed to this person
Charged
657.00
Total submitted
Denied
0.00
1 denied claims
Patient responsibility
293.80
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 | ELENA GARCIA |
| Role on the policy | Subscriber |
| Policy | B04M000032 |
| Date of birth | 8 May 1979 |
| Plan | GOLD PPO |
| Covered from | 7 May 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 50 · Other | 1 | 293.80 |
| Total | 293.80 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000141 | 17 May 2026 | 452.00 | CASCADE CARE | CARC 50 · MEDICAL_NECESSITY | 0.00 |
| CLM0000142 | 8 Apr 2026 | 205.00 | CASCADE CARE | Not denied | — |