MARCUS VARGAS
Subscriber on policy B05M000688
Claims
1
Attributed to this person
Charged
478.00
Total submitted
Denied
0.00
1 denied claims
Patient responsibility
310.70
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 | MARCUS VARGAS |
| Role on the policy | Subscriber |
| Policy | B05M000688 |
| Date of birth | 3 Nov 1999 |
| Plan | SILVER HMO |
| Covered from | 29 Jan 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 96 · Other | 1 | 310.70 |
| Total | 310.70 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002948 | 26 Apr 2025 | 478.00 | NORTHSTAR MUTUAL | CARC 96 · NON_COVERED | 0.00 |