CARLA GARCIA
Subscriber on policy B04M000197
Claims
3
Attributed to this person
Charged
1,178.00
Total submitted
Denied
13.72
1 denied claims
Patient responsibility
40.80
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 | CARLA GARCIA |
| Role on the policy | Subscriber |
| Policy | B04M000197 |
| Date of birth | 15 Dec 1973 |
| Plan | GOLD PPO |
| Covered from | 17 Mar 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 40.80 |
| Total | 40.80 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000875 | 28 May 2025 | 310.00 | CASCADE CARE | CARC 197 · AUTHORIZATION | 13.72 |
| CLM0000876 | 11 Mar 2025 | 272.00 | CASCADE CARE | Not denied | — |
| CLM0000877 | 24 Aug 2024 | 596.00 | CASCADE CARE | Not denied | — |