ZARA DIAZ
Dependent on policy B01M000751
Claims
3
Attributed to this person
Charged
1,598.00
Total submitted
Denied
804.00
1 denied claims
Patient responsibility
90.75
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 | ZARA DIAZ |
| Role on the policy | Dependent · relationship 01 |
| Policy | B01M000751 |
| Date of birth | 9 Nov 1973 |
| Plan | BRONZE EPO |
| Covered from | 9 Jan 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 90.75 |
| Total | 90.75 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003343 | 10 Jun 2025 | 189.00 | CASCADE CARE | Not denied | — |
| CLM0003341 | 21 Mar 2025 | 605.00 | CASCADE CARE | Not denied | — |
| CLM0003342 | 20 Dec 2024 | 804.00 | CASCADE CARE | CARC 27 · ELIGIBILITY | 804.00 |