HENRY DIAZ
Subscriber on policy B06M000857
Claims
3
Attributed to this person
Charged
2,049.00
Total submitted
Denied
1,772.00
2 denied claims
Patient responsibility
55.40
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 | HENRY DIAZ |
| Role on the policy | Subscriber |
| Policy | B06M000857 |
| Date of birth | 21 Sep 1997 |
| Plan | BRONZE EPO |
| Covered from | 7 Oct 2024 |
| Covered to | 11 Jun 2025 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 55.40 |
| Total | 55.40 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003751 | 21 Mar 2025 | 898.00 | NORTHSTAR MUTUAL | CARC 26 · ELIGIBILITY | 898.00 |
| CLM0003750 | 12 Mar 2025 | 874.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 874.00 |
| CLM0003752 | 6 Feb 2025 | 277.00 | NORTHSTAR MUTUAL | Not denied | — |