ELENA DIAZ
Dependent on policy B03M000638
Claims
3
Attributed to this person
Charged
1,499.00
Total submitted
Denied
0.00
1 denied claims
Patient responsibility
63.70
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 19 |
| Policy | B03M000638 |
| Date of birth | 18 Jun 2018 |
| Plan | PLATINUM PPO |
| Covered from | 28 Apr 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 50 · Other | 1 | 63.70 |
| Total | 63.70 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002638 | 20 Jul 2026 | 624.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0002636 | 19 May 2025 | 777.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0002637 | 28 Apr 2025 | 98.00 | MERIDIAN HEALTH PLAN | CARC 50 · MEDICAL_NECESSITY | 0.00 |