AMARA GARCIA
Subscriber on policy B05M000635
Claims
3
Attributed to this person
Charged
1,036.00
Total submitted
Denied
116.01
1 denied claims
Patient responsibility
25.00
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 | AMARA GARCIA |
| Role on the policy | Subscriber |
| Policy | B05M000635 |
| Date of birth | 17 May 1967 |
| Plan | SILVER HMO |
| Covered from | 25 Dec 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 3 · Copay | 1 | 25.00 |
| Total | 25.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002736 | 23 Jul 2026 | 109.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0002738 | 27 Jan 2026 | 285.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 116.01 |
| CLM0002737 | 8 Jan 2025 | 642.00 | NORTHSTAR MUTUAL | Not denied | — |