SOFIA GARCIA
Dependent on policy B05M000054
Claims
3
Attributed to this person
Charged
1,169.00
Total submitted
Denied
410.00
2 denied claims
Patient responsibility
177.45
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 | SOFIA GARCIA |
| Role on the policy | Dependent · relationship 19 |
| Policy | B05M000054 |
| Date of birth | 14 Dec 1998 |
| Plan | BRONZE EPO |
| Covered from | 5 Jan 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 50 · Other | 1 | 177.45 |
| Total | 177.45 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000272 | 6 Jan 2026 | 486.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0000273 | 12 Nov 2025 | 273.00 | NORTHSTAR MUTUAL | CARC 50 · MEDICAL_NECESSITY | 0.00 |
| CLM0000274 | 18 Apr 2025 | 410.00 | NORTHSTAR MUTUAL | CARC 16 · BILLING_ERROR | 410.00 |