AMARA DIAZ
Dependent on policy B01M000751
Claims
3
Attributed to this person
Charged
1,438.00
Total submitted
Denied
0.00
1 denied claims
Patient responsibility
551.20
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 | AMARA DIAZ |
| Role on the policy | Dependent · relationship 19 |
| Policy | B01M000751 |
| Date of birth | 16 Apr 2001 |
| Plan | BRONZE EPO |
| Covered from | 9 Jan 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 50 · Other | 1 | 551.20 |
| Total | 551.20 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003344 | 19 Apr 2025 | 70.00 | CASCADE CARE | Not denied | — |
| CLM0003346 | 12 Jul 2024 | 520.00 | CASCADE CARE | Not denied | — |
| CLM0003345 | 26 Mar 2024 | 848.00 | CASCADE CARE | CARC 50 · MEDICAL_NECESSITY | 0.00 |