RAVI DIAZ
Dependent on policy B09M000253
Claims
3
Attributed to this person
Charged
1,679.00
Total submitted
Denied
653.00
1 denied claims
Patient responsibility
23.10
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 | RAVI DIAZ |
| Role on the policy | Dependent · relationship 19 |
| Policy | B09M000253 |
| Date of birth | 24 Jul 1986 |
| Plan | PLATINUM PPO |
| Covered from | 19 Jun 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 23.10 |
| Total | 23.10 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001022 | 11 Feb 2025 | 154.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0001023 | 8 Nov 2024 | 653.00 | MERIDIAN HEALTH PLAN | CARC 96 · NON_COVERED | 653.00 |
| CLM0001021 | 11 Sep 2024 | 872.00 | MERIDIAN HEALTH PLAN | Not denied | — |