CARLA DIAZ
Subscriber on policy B01M000698
Claims
1
Attributed to this person
Charged
576.00
Total submitted
Denied
576.00
1 denied claims
Patient responsibility
0.00
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 | CARLA DIAZ |
| Role on the policy | Subscriber |
| Policy | B01M000698 |
| Date of birth | 14 Aug 1963 |
| Plan | SILVER HMO |
| Covered from | 1 Dec 2024 |
| Covered to | 5 Sep 2025 |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003128 | 25 Dec 2024 | 576.00 | MERIDIAN HEALTH PLAN | CARC 18 · DUPLICATE | 576.00 |