TOMAS GARCIA
Dependent on policy B04M000412
Claims
3
Attributed to this person
Charged
662.00
Total submitted
Denied
404.31
3 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 GARCIA |
| Role on the policy | Dependent · relationship 01 |
| Policy | B04M000412 |
| Date of birth | 3 Mar 1981 |
| Plan | BRONZE EPO |
| Covered from | 23 Jan 2025 |
| Covered to | 14 Jul 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 |
|---|---|---|---|---|---|
| CLM0001764 | 3 May 2025 | 263.00 | CASCADE CARE | CARC 16 · BILLING_ERROR | 5.31 |
| CLM0001762 | 24 Apr 2025 | 265.00 | CASCADE CARE | CARC 27 · ELIGIBILITY | 265.00 |
| CLM0001763 | 28 Dec 2024 | 134.00 | CASCADE CARE | CARC 26 · ELIGIBILITY | 134.00 |