BRIAN GARCIA
Dependent on policy B05M000394
Claims
3
Attributed to this person
Charged
1,238.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
67.20
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 | BRIAN GARCIA |
| Role on the policy | Dependent · relationship 01 |
| Policy | B05M000394 |
| Date of birth | 4 Dec 1958 |
| Plan | PLATINUM PPO |
| Covered from | 1 Jan 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 67.20 |
| Total | 67.20 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001684 | 26 Aug 2026 | 235.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0001685 | 12 Jun 2026 | 336.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0001683 | 29 Jun 2024 | 667.00 | NORTHSTAR MUTUAL | Not denied | — |