RAVI DIAZ
Dependent on policy B09M000011
Claims
2
Attributed to this person
Charged
795.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
31.80
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 | RAVI DIAZ |
| Role on the policy | Dependent · relationship 01 |
| Policy | B09M000011 |
| Date of birth | 25 Dec 1960 |
| Plan | GOLD PPO |
| Covered from | 2 Jan 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 31.80 |
| Total | 31.80 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000044 | 7 Apr 2026 | 212.00 | CASCADE CARE | Not denied | — |
| CLM0000043 | 14 Jun 2025 | 583.00 | CASCADE CARE | Not denied | — |