AMARA DIAZ
Dependent on policy B04M000518
Claims
1
Attributed to this person
Charged
409.00
Total submitted
Denied
0.00
1 denied claims
Patient responsibility
265.85
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 | B04M000518 |
| Date of birth | 12 Nov 1973 |
| Plan | GOLD PPO |
| Covered from | 4 Jan 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 96 · Other | 1 | 265.85 |
| Total | 265.85 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002246 | 3 Mar 2026 | 409.00 | MERIDIAN HEALTH PLAN | CARC 96 · NON_COVERED | 0.00 |