UMA GARCIA
Dependent on policy B05M000266
Claims
1
Attributed to this person
Charged
557.00
Total submitted
Denied
557.00
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 | UMA GARCIA |
| Role on the policy | Dependent · relationship 01 |
| Policy | B05M000266 |
| Date of birth | 29 May 1990 |
| Plan | GOLD PPO |
| Covered from | 7 May 2024 |
| Covered to | 12 Dec 2024 |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001105 | 17 Apr 2024 | 557.00 | MERIDIAN HEALTH PLAN | CARC 26 · ELIGIBILITY | 557.00 |