ELENA DIAZ
Subscriber on policy B07M000221
Claims
2
Attributed to this person
Charged
839.00
Total submitted
Denied
0.00
1 denied claims
Patient responsibility
185.90
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 | B07M000221 |
| Date of birth | 22 Jul 1975 |
| Plan | SILVER HMO |
| Covered from | 29 Sep 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 96 · Other | 1 | 185.90 |
| Total | 185.90 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000923 | 18 Nov 2025 | 553.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0000922 | 11 Dec 2024 | 286.00 | MERIDIAN HEALTH PLAN | CARC 96 · NON_COVERED | 0.00 |