DAVID GARCIA
Dependent on policy B05M000779
Claims
2
Attributed to this person
Charged
894.00
Total submitted
Denied
426.00
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 | DAVID GARCIA |
| Role on the policy | Dependent · relationship 19 |
| Policy | B05M000779 |
| Date of birth | 3 Oct 1984 |
| Plan | GOLD PPO |
| Covered from | 24 Aug 2024 |
| Covered to | 8 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 |
|---|---|---|---|---|---|
| CLM0003325 | 30 Dec 2024 | 426.00 | MERIDIAN HEALTH PLAN | CARC 27 · ELIGIBILITY | 426.00 |
| CLM0003324 | 10 Dec 2024 | 468.00 | MERIDIAN HEALTH PLAN | Not denied | — |