SOFIA DIAZ
Subscriber on policy B05M000677
Claims
3
Attributed to this person
Charged
2,099.00
Total submitted
Denied
628.07
2 denied claims
Patient responsibility
0.00
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 | SOFIA DIAZ |
| Role on the policy | Subscriber |
| Policy | B05M000677 |
| Date of birth | 24 May 1953 |
| Plan | BRONZE EPO |
| Covered from | 16 Apr 2025 |
| Covered to | 10 Aug 2025 |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002917 | 5 Oct 2025 | 608.00 | CASCADE CARE | CARC 27 · ELIGIBILITY | 608.00 |
| CLM0002916 | 19 Jul 2025 | 879.00 | CASCADE CARE | Not denied | — |
| CLM0002918 | 4 Jul 2025 | 612.00 | CASCADE CARE | CARC 11 · CODING | 20.07 |