ELENA DIAZ
Subscriber on policy B06M000224
Claims
3
Attributed to this person
Charged
823.00
Total submitted
Denied
463.00
2 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 | ELENA DIAZ |
| Role on the policy | Subscriber |
| Policy | B06M000224 |
| Date of birth | 3 Feb 1953 |
| Plan | BRONZE EPO |
| Covered from | 3 May 2024 |
| Covered to | 10 Aug 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 |
|---|---|---|---|---|---|
| CLM0001068 | 27 Aug 2024 | 126.00 | CASCADE CARE | CARC 27 · ELIGIBILITY | 126.00 |
| CLM0001069 | 21 May 2024 | 337.00 | CASCADE CARE | CARC 197 · AUTHORIZATION | 337.00 |
| CLM0001070 | 9 May 2024 | 360.00 | CASCADE CARE | Not denied | — |