FIONA DIAZ
Dependent on policy B05M000632
Claims
3
Attributed to this person
Charged
623.00
Total submitted
Denied
421.00
2 denied claims
Patient responsibility
40.40
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 | FIONA DIAZ |
| Role on the policy | Dependent · relationship 19 |
| Policy | B05M000632 |
| Date of birth | 22 Aug 2003 |
| Plan | BRONZE EPO |
| Covered from | 29 Mar 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 40.40 |
| Total | 40.40 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002725 | 28 Mar 2026 | 273.00 | CASCADE CARE | CARC 197 · AUTHORIZATION | 273.00 |
| CLM0002727 | 5 Nov 2025 | 148.00 | CASCADE CARE | CARC 18 · DUPLICATE | 148.00 |
| CLM0002726 | 23 Apr 2025 | 202.00 | CASCADE CARE | Not denied | — |