FIONA DIAZ
Dependent on policy B06M000224
Claims
3
Attributed to this person
Charged
1,258.00
Total submitted
Denied
971.00
2 denied claims
Patient responsibility
43.05
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 | FIONA DIAZ |
| Role on the policy | Dependent · relationship 19 |
| Policy | B06M000224 |
| Date of birth | 23 Mar 1989 |
| Plan | BRONZE EPO |
| Covered from | 3 May 2024 |
| Covered to | 10 Aug 2024 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 43.05 |
| Total | 43.05 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001074 | 4 Oct 2024 | 287.00 | CASCADE CARE | Not denied | — |
| CLM0001075 | 12 Jun 2024 | 539.00 | CASCADE CARE | CARC 27 · ELIGIBILITY | 539.00 |
| CLM0001073 | 5 Apr 2024 | 432.00 | CASCADE CARE | CARC 26 · ELIGIBILITY | 432.00 |