DAVID VARGAS
Dependent on policy B05M000836
Claims
1
Attributed to this person
Charged
167.00
Total submitted
Denied
0.00
1 denied claims
Patient responsibility
108.55
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 | DAVID VARGAS |
| Role on the policy | Dependent · relationship 01 |
| Policy | B05M000836 |
| Date of birth | 11 Apr 1951 |
| Plan | BRONZE EPO |
| Covered from | 8 May 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 96 · Other | 1 | 108.55 |
| Total | 108.55 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003546 | 5 May 2025 | 167.00 | CASCADE CARE | CARC 96 · NON_COVERED | 0.00 |