VICTOR DIAZ
Dependent on policy B05M000163
Claims
3
Attributed to this person
Charged
1,333.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
161.85
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 | VICTOR DIAZ |
| Role on the policy | Dependent · relationship 01 |
| Policy | B05M000163 |
| Date of birth | 4 Mar 1986 |
| Plan | PLATINUM PPO |
| Covered from | 24 Sep 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 2 | 161.85 |
| Total | 161.85 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000687 | 15 Jul 2026 | 254.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0000688 | 30 Jan 2026 | 615.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0000689 | 14 Jan 2025 | 464.00 | MERIDIAN HEALTH PLAN | Not denied | — |