DAVID DIAZ
Subscriber on policy B07M000213
Claims
3
Attributed to this person
Charged
1,663.00
Total submitted
Denied
147.00
1 denied claims
Patient responsibility
133.80
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 DIAZ |
| Role on the policy | Subscriber |
| Policy | B07M000213 |
| Date of birth | 13 Nov 1962 |
| Plan | GOLD PPO |
| Covered from | 24 Jun 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 133.80 |
| Total | 133.80 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000886 | 6 Aug 2025 | 847.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0000888 | 29 May 2025 | 147.00 | MERIDIAN HEALTH PLAN | CARC 27 · ELIGIBILITY | 147.00 |
| CLM0000887 | 5 May 2025 | 669.00 | MERIDIAN HEALTH PLAN | Not denied | — |