ELENA DIAZ
Dependent on policy B02M000577
Claims
3
Attributed to this person
Charged
1,456.00
Total submitted
Denied
348.00
1 denied claims
Patient responsibility
30.00
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 | ELENA DIAZ |
| Role on the policy | Dependent · relationship 01 |
| Policy | B02M000577 |
| Date of birth | 11 Dec 1995 |
| Plan | GOLD PPO |
| Covered from | 9 Sep 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 3 · Copay | 1 | 30.00 |
| Total | 30.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002424 | 4 Feb 2025 | 786.00 | CASCADE CARE | Not denied | — |
| CLM0002426 | 28 Oct 2024 | 322.00 | CASCADE CARE | Not denied | — |
| CLM0002425 | 23 Aug 2024 | 348.00 | CASCADE CARE | CARC 18 · DUPLICATE | 348.00 |