WENDY DIAZ
Dependent on policy B01M000547
Claims
2
Attributed to this person
Charged
592.00
Total submitted
Denied
0.00
0 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 | WENDY DIAZ |
| Role on the policy | Dependent · relationship 01 |
| Policy | B01M000547 |
| Date of birth | 8 Feb 1992 |
| Plan | GOLD PPO |
| Covered from | 17 Aug 2024 |
| Covered to | 26 Dec 2024 |
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 |
|---|---|---|---|---|---|
| CLM0002458 | 2 Nov 2024 | 285.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0002457 | 2 Oct 2024 | 307.00 | MERIDIAN HEALTH PLAN | Not denied | — |