CARLA DIAZ
Subscriber on policy B01M000002
Claims
1
Attributed to this person
Charged
650.00
Total submitted
Denied
650.00
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 | CARLA DIAZ |
| Role on the policy | Subscriber |
| Policy | B01M000002 |
| Date of birth | 10 Mar 2003 |
| Plan | PLATINUM PPO |
| Covered from | 20 Feb 2025 |
| 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 |
|---|---|---|---|---|---|
| CLM0000008 | 11 Aug 2025 | 650.00 | MERIDIAN HEALTH PLAN | CARC 27 · ELIGIBILITY | 650.00 |