ZARA GARCIA
Subscriber on policy B06M000259
Claims
3
Attributed to this person
Charged
1,854.00
Total submitted
Denied
986.00
3 denied claims
Patient responsibility
564.20
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 | ZARA GARCIA |
| Role on the policy | Subscriber |
| Policy | B06M000259 |
| Date of birth | 14 Apr 1983 |
| Plan | BRONZE EPO |
| Covered from | 20 Oct 2024 |
| Covered to | 24 Jan 2025 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 96 · Other | 1 | 564.20 |
| Total | 564.20 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001224 | 27 Jan 2025 | 868.00 | MERIDIAN HEALTH PLAN | CARC 96 · NON_COVERED | 0.00 |
| CLM0001223 | 15 Nov 2024 | 709.00 | MERIDIAN HEALTH PLAN | CARC 27 · ELIGIBILITY | 709.00 |
| CLM0001225 | 22 Sep 2024 | 277.00 | MERIDIAN HEALTH PLAN | CARC 29 · TIMELY_FILING | 277.00 |