ZARA GARCIA
Subscriber on policy B05M000021
Claims
3
Attributed to this person
Charged
1,024.00
Total submitted
Denied
370.99
2 denied claims
Patient responsibility
24.60
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 | ZARA GARCIA |
| Role on the policy | Subscriber |
| Policy | B05M000021 |
| Date of birth | 7 May 1998 |
| Plan | PLATINUM PPO |
| Covered from | 31 Jan 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 24.60 |
| Total | 24.60 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000101 | 13 Dec 2025 | 164.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0000100 | 21 Jul 2025 | 84.00 | MERIDIAN HEALTH PLAN | CARC 29 · TIMELY_FILING | 84.00 |
| CLM0000099 | 1 Mar 2025 | 776.00 | MERIDIAN HEALTH PLAN | CARC 29 · TIMELY_FILING | 286.99 |