ELENA GARCIA
Dependent on policy B04M000547
Claims
1
Attributed to this person
Charged
328.00
Total submitted
Denied
0.00
1 denied claims
Patient responsibility
213.20
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 | Dependent · relationship 19 |
| Policy | B04M000547 |
| Date of birth | 4 Dec 1991 |
| Plan | GOLD PPO |
| Covered from | 14 Mar 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 96 · Other | 1 | 213.20 |
| Total | 213.20 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002410 | 3 Jan 2026 | 328.00 | CASCADE CARE | CARC 96 · NON_COVERED | 0.00 |