DAVID DIAZ
Subscriber on policy B01M000111
Claims
3
Attributed to this person
Charged
1,663.00
Total submitted
Denied
1,318.00
2 denied claims
Patient responsibility
51.75
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 | DAVID DIAZ |
| Role on the policy | Subscriber |
| Policy | B01M000111 |
| Date of birth | 8 Jan 1965 |
| Plan | PLATINUM PPO |
| Covered from | 4 May 2024 |
| Covered to | 7 Oct 2024 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 51.75 |
| Total | 51.75 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000438 | 24 Oct 2024 | 345.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0000437 | 17 May 2024 | 720.00 | MERIDIAN HEALTH PLAN | CARC 27 · ELIGIBILITY | 720.00 |
| CLM0000439 | 26 Apr 2024 | 598.00 | MERIDIAN HEALTH PLAN | CARC 26 · ELIGIBILITY | 598.00 |