SOFIA GARCIA
Dependent on policy B05M000693
Claims
3
Attributed to this person
Charged
1,486.00
Total submitted
Denied
557.00
2 denied claims
Patient responsibility
469.30
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 | B05M000693 |
| Date of birth | 4 Jun 2016 |
| Plan | BRONZE EPO |
| Covered from | 19 Dec 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 96 · Other | 1 | 469.30 |
| Total | 469.30 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002980 | 12 Oct 2025 | 207.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0002978 | 8 Oct 2025 | 722.00 | NORTHSTAR MUTUAL | CARC 96 · NON_COVERED | 0.00 |
| CLM0002979 | 25 Nov 2024 | 557.00 | NORTHSTAR MUTUAL | CARC 26 · ELIGIBILITY | 557.00 |