FIONA DIAZ
Dependent on policy B06M000431
Claims
2
Attributed to this person
Charged
716.00
Total submitted
Denied
11.96
1 denied claims
Patient responsibility
20.40
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 01 |
| Policy | B06M000431 |
| Date of birth | 4 Feb 1991 |
| Plan | GOLD PPO |
| Covered from | 30 Oct 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 20.40 |
| Total | 20.40 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001984 | 18 Apr 2026 | 102.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0001985 | 27 Jun 2025 | 614.00 | MERIDIAN HEALTH PLAN | CARC 96 · NON_COVERED | 11.96 |