NADIA DIAZ
Subscriber on policy B07M000028
Claims
3
Attributed to this person
Charged
1,872.00
Total submitted
Denied
548.00
1 denied claims
Patient responsibility
138.80
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 | NADIA DIAZ |
| Role on the policy | Subscriber |
| Policy | B07M000028 |
| Date of birth | 30 Jan 1982 |
| Plan | PLATINUM PPO |
| Covered from | 8 Feb 2025 |
| Covered to | 9 Aug 2025 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 138.80 |
| Total | 138.80 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000121 | 23 Jun 2025 | 694.00 | CASCADE CARE | Not denied | — |
| CLM0000123 | 6 May 2025 | 630.00 | CASCADE CARE | Not denied | — |
| CLM0000122 | 17 Jan 2025 | 548.00 | CASCADE CARE | CARC 26 · ELIGIBILITY | 548.00 |