ZARA GARCIA
Dependent on policy B01M000135
Claims
1
Attributed to this person
Charged
362.00
Total submitted
Denied
0.00
1 denied claims
Patient responsibility
235.30
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 | ZARA GARCIA |
| Role on the policy | Dependent · relationship 01 |
| Policy | B01M000135 |
| Date of birth | 27 May 1944 |
| Plan | PLATINUM PPO |
| Covered from | 8 Apr 2025 |
| Covered to | 31 Jul 2025 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 50 · Other | 1 | 235.30 |
| Total | 235.30 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000549 | 16 Apr 2025 | 362.00 | MERIDIAN HEALTH PLAN | CARC 50 · MEDICAL_NECESSITY | 0.00 |