ELENA DIAZ
Dependent on policy B10M000193
Claims
2
Attributed to this person
Charged
1,391.00
Total submitted
Denied
0.00
1 denied claims
Patient responsibility
517.40
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 | ELENA DIAZ |
| Role on the policy | Dependent · relationship 19 |
| Policy | B10M000193 |
| Date of birth | 21 Jun 1990 |
| Plan | BRONZE EPO |
| Covered from | 23 Jun 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 96 · Other | 1 | 517.40 |
| Total | 517.40 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000799 | 10 May 2026 | 595.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0000798 | 17 Jan 2025 | 796.00 | MERIDIAN HEALTH PLAN | CARC 96 · NON_COVERED | 0.00 |