PRIYA GARCIA
Dependent on policy B04M000823
Claims
2
Attributed to this person
Charged
947.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
104.80
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 | PRIYA GARCIA |
| Role on the policy | Dependent · relationship 01 |
| Policy | B04M000823 |
| Date of birth | 16 Dec 1981 |
| Plan | SILVER HMO |
| Covered from | 27 Jul 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 104.80 |
| Total | 104.80 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003574 | 31 Mar 2026 | 423.00 | CASCADE CARE | Not denied | — |
| CLM0003575 | 8 Mar 2026 | 524.00 | CASCADE CARE | Not denied | — |