GRACE GARCIA
Dependent on policy B04M000547
Claims
2
Attributed to this person
Charged
1,306.00
Total submitted
Denied
471.00
1 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 | GRACE GARCIA |
| Role on the policy | Dependent · relationship 01 |
| Policy | B04M000547 |
| Date of birth | 25 Nov 1950 |
| Plan | GOLD PPO |
| Covered from | 14 Mar 2024 |
| Covered to | open |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002408 | 28 Oct 2025 | 471.00 | CASCADE CARE | CARC 27 · ELIGIBILITY | 471.00 |
| CLM0002409 | 22 Sep 2024 | 835.00 | CASCADE CARE | Not denied | — |