LEILA DIAZ
Subscriber on policy B06M000851
Claims
2
Attributed to this person
Charged
1,365.00
Total submitted
Denied
760.00
1 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 | LEILA DIAZ |
| Role on the policy | Subscriber |
| Policy | B06M000851 |
| Date of birth | 30 Jul 1957 |
| Plan | PLATINUM PPO |
| Covered from | 27 Jun 2024 |
| Covered to | open |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003717 | 20 Feb 2025 | 605.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0003718 | 25 Nov 2024 | 760.00 | NORTHSTAR MUTUAL | CARC 16 · BILLING_ERROR | 760.00 |