RAVI DIAZ
Dependent on policy B10M000790
Claims
1
Attributed to this person
Charged
485.00
Total submitted
Denied
485.00
1 denied claims
Patient responsibility
0.00
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 | Dependent · relationship 01 |
| Policy | B10M000790 |
| Date of birth | 21 Oct 1974 |
| Plan | BRONZE EPO |
| Covered from | 30 May 2024 |
| Covered to | 17 Jan 2025 |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003334 | 22 Feb 2025 | 485.00 | MERIDIAN HEALTH PLAN | CARC 27 · ELIGIBILITY | 485.00 |