VICTOR VARGAS
Subscriber on policy B05M000867
Claims
2
Attributed to this person
Charged
1,427.00
Total submitted
Denied
584.00
1 denied claims
Patient responsibility
0.00
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 | VICTOR VARGAS |
| Role on the policy | Subscriber |
| Policy | B05M000867 |
| Date of birth | 2 Dec 1993 |
| Plan | GOLD PPO |
| Covered from | 11 Feb 2024 |
| Covered to | 24 Jun 2024 |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003680 | 20 Aug 2024 | 584.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 584.00 |
| CLM0003681 | 3 May 2024 | 843.00 | NORTHSTAR MUTUAL | Not denied | — |