WENDY DIAZ
Subscriber on policy B04M000036
Claims
2
Attributed to this person
Charged
693.00
Total submitted
Denied
274.00
1 denied claims
Patient responsibility
83.80
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 | Subscriber |
| Policy | B04M000036 |
| Date of birth | 28 Apr 1954 |
| Plan | BRONZE EPO |
| Covered from | 26 Jul 2024 |
| Covered to | 9 Mar 2025 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 83.80 |
| Total | 83.80 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000156 | 17 Aug 2024 | 274.00 | MERIDIAN HEALTH PLAN | CARC 27 · ELIGIBILITY | 274.00 |
| CLM0000157 | 7 Jul 2024 | 419.00 | MERIDIAN HEALTH PLAN | Not denied | — |