ZARA VARGAS
Dependent on policy B05M000491
Claims
3
Attributed to this person
Charged
969.00
Total submitted
Denied
140.00
2 denied claims
Patient responsibility
105.95
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 VARGAS |
| Role on the policy | Dependent · relationship 01 |
| Policy | B05M000491 |
| Date of birth | 7 Mar 2001 |
| Plan | GOLD PPO |
| Covered from | 20 Mar 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 96 · Other | 1 | 105.95 |
| Total | 105.95 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002097 | 4 Jun 2025 | 666.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0002099 | 25 May 2025 | 140.00 | MERIDIAN HEALTH PLAN | CARC 11 · CODING | 140.00 |
| CLM0002098 | 29 Apr 2025 | 163.00 | MERIDIAN HEALTH PLAN | CARC 96 · NON_COVERED | 0.00 |