AMARA DIAZ
Subscriber on policy B01M000020
Claims
2
Attributed to this person
Charged
629.00
Total submitted
Denied
0.00
1 denied claims
Patient responsibility
206.05
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 | AMARA DIAZ |
| Role on the policy | Subscriber |
| Policy | B01M000020 |
| Date of birth | 1 Sep 1995 |
| Plan | PLATINUM PPO |
| Covered from | 1 May 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 96 · Other | 1 | 206.05 |
| Total | 206.05 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000075 | 29 Jun 2026 | 312.00 | CASCADE CARE | Not denied | — |
| CLM0000074 | 4 Jun 2025 | 317.00 | CASCADE CARE | CARC 96 · NON_COVERED | 0.00 |