SOFIA DIAZ
Subscriber on policy B01M000628
Claims
3
Attributed to this person
Charged
1,779.00
Total submitted
Denied
879.00
1 denied claims
Patient responsibility
39.45
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 | SOFIA DIAZ |
| Role on the policy | Subscriber |
| Policy | B01M000628 |
| Date of birth | 24 May 2003 |
| Plan | SILVER HMO |
| Covered from | 8 Mar 2025 |
| Covered to | 20 Jul 2025 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 39.45 |
| Total | 39.45 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002803 | 23 Jun 2025 | 879.00 | CASCADE CARE | CARC 18 · DUPLICATE | 879.00 |
| CLM0002804 | 19 Jun 2025 | 637.00 | CASCADE CARE | Not denied | — |
| CLM0002805 | 18 Jun 2025 | 263.00 | CASCADE CARE | Not denied | — |