UMA DIAZ
Dependent on policy B09M000066
Claims
3
Attributed to this person
Charged
880.00
Total submitted
Denied
79.52
1 denied claims
Patient responsibility
65.55
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 | UMA DIAZ |
| Role on the policy | Dependent · relationship 01 |
| Policy | B09M000066 |
| Date of birth | 30 Jan 1996 |
| Plan | PLATINUM PPO |
| Covered from | 21 May 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 65.55 |
| Total | 65.55 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000294 | 18 Jul 2026 | 437.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0000295 | 18 Jun 2026 | 252.00 | MERIDIAN HEALTH PLAN | CARC 11 · CODING | 79.52 |
| CLM0000293 | 1 Oct 2025 | 191.00 | MERIDIAN HEALTH PLAN | Not denied | — |