WENDY DIAZ
Dependent on policy B01M000111
Claims
3
Attributed to this person
Charged
708.00
Total submitted
Denied
283.00
1 denied claims
Patient responsibility
54.00
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 | WENDY DIAZ |
| Role on the policy | Dependent · relationship 01 |
| Policy | B01M000111 |
| Date of birth | 2 Dec 1970 |
| 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 | 54.00 |
| Total | 54.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000442 | 14 Jul 2024 | 360.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0000441 | 20 Apr 2024 | 283.00 | MERIDIAN HEALTH PLAN | CARC 26 · ELIGIBILITY | 283.00 |
| CLM0000440 | 10 Apr 2024 | 65.00 | MERIDIAN HEALTH PLAN | Not denied | — |