CARLA DIAZ
Subscriber on policy B09M000597
Claims
3
Attributed to this person
Charged
1,424.00
Total submitted
Denied
897.00
2 denied claims
Patient responsibility
123.50
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 | CARLA DIAZ |
| Role on the policy | Subscriber |
| Policy | B09M000597 |
| Date of birth | 5 Jul 1977 |
| Plan | GOLD PPO |
| Covered from | 3 Mar 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 50 · Other | 1 | 123.50 |
| Total | 123.50 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002528 | 4 Sep 2025 | 337.00 | CASCADE CARE | Not denied | — |
| CLM0002527 | 2 Feb 2025 | 897.00 | CASCADE CARE | CARC 27 · ELIGIBILITY | 897.00 |
| CLM0002529 | 26 Jun 2024 | 190.00 | CASCADE CARE | CARC 50 · MEDICAL_NECESSITY | 0.00 |