AMARA DIAZ
Dependent on policy B01M000550
Claims
2
Attributed to this person
Charged
729.00
Total submitted
Denied
0.00
1 denied claims
Patient responsibility
195.65
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 | AMARA DIAZ |
| Role on the policy | Dependent · relationship 01 |
| Policy | B01M000550 |
| Date of birth | 13 May 1990 |
| Plan | BRONZE EPO |
| Covered from | 7 Jun 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 96 · Other | 1 | 195.65 |
| Total | 195.65 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002469 | 5 Jul 2026 | 428.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0002468 | 30 Jul 2025 | 301.00 | MERIDIAN HEALTH PLAN | CARC 96 · NON_COVERED | 0.00 |