RAVI DIAZ
Subscriber on policy B06M000431
Claims
2
Attributed to this person
Charged
1,191.00
Total submitted
Denied
610.00
1 denied claims
Patient responsibility
87.15
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 | RAVI DIAZ |
| Role on the policy | Subscriber |
| Policy | B06M000431 |
| Date of birth | 28 Feb 1996 |
| Plan | GOLD PPO |
| Covered from | 30 Oct 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 87.15 |
| Total | 87.15 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001983 | 20 Jun 2025 | 581.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0001982 | 8 Apr 2025 | 610.00 | MERIDIAN HEALTH PLAN | CARC 27 · ELIGIBILITY | 610.00 |