TOMAS DIAZ
Subscriber on policy B10M000760
Claims
3
Attributed to this person
Charged
468.00
Total submitted
Denied
114.82
2 denied claims
Patient responsibility
46.80
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 | TOMAS DIAZ |
| Role on the policy | Subscriber |
| Policy | B10M000760 |
| Date of birth | 23 Jun 1993 |
| Plan | GOLD PPO |
| Covered from | 13 May 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 96 · Other | 1 | 46.80 |
| Total | 46.80 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003185 | 20 Jul 2026 | 105.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0003187 | 18 Nov 2025 | 291.00 | MERIDIAN HEALTH PLAN | CARC 96 · NON_COVERED | 114.82 |
| CLM0003186 | 17 Sep 2025 | 72.00 | MERIDIAN HEALTH PLAN | CARC 96 · NON_COVERED | 0.00 |