TOMAS DIAZ
Dependent on policy B09M000837
Claims
3
Attributed to this person
Charged
1,260.00
Total submitted
Denied
63.00
1 denied claims
Patient responsibility
94.80
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 | TOMAS DIAZ |
| Role on the policy | Dependent · relationship 19 |
| Policy | B09M000837 |
| Date of birth | 25 Nov 2005 |
| Plan | BRONZE EPO |
| Covered from | 3 May 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 94.80 |
| Total | 94.80 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003566 | 3 Apr 2025 | 474.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0003568 | 24 Nov 2024 | 723.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0003567 | 14 Nov 2024 | 63.00 | MERIDIAN HEALTH PLAN | CARC 29 · TIMELY_FILING | 63.00 |