CARLA DIAZ
Subscriber on policy B10M000623
Claims
2
Attributed to this person
Charged
1,002.00
Total submitted
Denied
602.02
2 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 | CARLA DIAZ |
| Role on the policy | Subscriber |
| Policy | B10M000623 |
| Date of birth | 21 Nov 1966 |
| Plan | BRONZE EPO |
| Covered from | 3 Jan 2024 |
| Covered to | open |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002599 | 15 Mar 2026 | 500.00 | CASCADE CARE | CARC 29 · TIMELY_FILING | 100.02 |
| CLM0002598 | 1 Dec 2024 | 502.00 | CASCADE CARE | CARC 27 · ELIGIBILITY | 502.00 |