UMA DIAZ
Dependent on policy B05M000883
Claims
3
Attributed to this person
Charged
1,382.00
Total submitted
Denied
780.00
1 denied claims
Patient responsibility
18.30
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 | UMA DIAZ |
| Role on the policy | Dependent · relationship 01 |
| Policy | B05M000883 |
| Date of birth | 29 Aug 1976 |
| Plan | PLATINUM PPO |
| Covered from | 4 Jan 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 18.30 |
| Total | 18.30 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003752 | 30 Jun 2025 | 480.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0003751 | 3 May 2025 | 122.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0003753 | 16 Aug 2024 | 780.00 | MERIDIAN HEALTH PLAN | CARC 18 · DUPLICATE | 780.00 |