ELENA DIAZ
Subscriber on policy B06M000356
Claims
3
Attributed to this person
Charged
1,135.00
Total submitted
Denied
518.00
1 denied claims
Patient responsibility
50.00
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 | ELENA DIAZ |
| Role on the policy | Subscriber |
| Policy | B06M000356 |
| Date of birth | 14 Jan 1979 |
| Plan | SILVER HMO |
| Covered from | 25 Oct 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 3 · Copay | 1 | 50.00 |
| Total | 50.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001621 | 27 Aug 2026 | 242.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0001623 | 21 Dec 2025 | 518.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 518.00 |
| CLM0001622 | 5 Dec 2025 | 375.00 | NORTHSTAR MUTUAL | Not denied | — |