RAVI DIAZ
Subscriber on policy B10M000160
Claims
3
Attributed to this person
Charged
1,485.00
Total submitted
Denied
81.00
1 denied claims
Patient responsibility
105.40
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 | Subscriber |
| Policy | B10M000160 |
| Date of birth | 7 Aug 1974 |
| Plan | BRONZE EPO |
| Covered from | 16 Nov 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 105.40 |
| Total | 105.40 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000659 | 11 Jan 2026 | 527.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0000657 | 11 Sep 2025 | 877.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0000658 | 12 Feb 2025 | 81.00 | MERIDIAN HEALTH PLAN | CARC 27 · ELIGIBILITY | 81.00 |