WENDY GARCIA
Subscriber on policy B05M000054
Claims
3
Attributed to this person
Charged
1,808.00
Total submitted
Denied
724.00
1 denied claims
Patient responsibility
62.55
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 | WENDY GARCIA |
| Role on the policy | Subscriber |
| Policy | B05M000054 |
| Date of birth | 12 May 1957 |
| Plan | BRONZE EPO |
| Covered from | 5 Jan 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 62.55 |
| Total | 62.55 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000266 | 7 Jul 2026 | 667.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0000265 | 13 Jul 2025 | 417.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0000267 | 24 Mar 2025 | 724.00 | NORTHSTAR MUTUAL | CARC 197 · AUTHORIZATION | 724.00 |