FIONA DIAZ
Dependent on policy B02M000883
Claims
3
Attributed to this person
Charged
1,220.00
Total submitted
Denied
316.00
2 denied claims
Patient responsibility
339.30
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 | FIONA DIAZ |
| Role on the policy | Dependent · relationship 01 |
| Policy | B02M000883 |
| Date of birth | 22 Jul 1964 |
| Plan | PLATINUM PPO |
| Covered from | 30 Dec 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 96 · Other | 1 | 339.30 |
| Total | 339.30 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003673 | 27 Nov 2025 | 382.00 | CASCADE CARE | Not denied | — |
| CLM0003672 | 28 Apr 2025 | 522.00 | CASCADE CARE | CARC 96 · NON_COVERED | 0.00 |
| CLM0003674 | 8 Dec 2024 | 316.00 | CASCADE CARE | CARC 26 · ELIGIBILITY | 316.00 |