VICTOR GARCIA
Dependent on policy B04M000633
Claims
1
Attributed to this person
Charged
540.00
Total submitted
Denied
540.00
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 | VICTOR GARCIA |
| Role on the policy | Dependent · relationship 19 |
| Policy | B04M000633 |
| Date of birth | 9 Jul 2014 |
| Plan | BRONZE EPO |
| Covered from | 5 May 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 |
|---|---|---|---|---|---|
| CLM0002752 | 13 Aug 2024 | 540.00 | CASCADE CARE | CARC 197 · AUTHORIZATION | 540.00 |