DAVID DIAZ
Subscriber on policy B06M000626
Claims
3
Attributed to this person
Charged
1,556.00
Total submitted
Denied
248.00
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 | DAVID DIAZ |
| Role on the policy | Subscriber |
| Policy | B06M000626 |
| Date of birth | 1 Sep 1983 |
| Plan | SILVER HMO |
| Covered from | 8 May 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 |
|---|---|---|---|---|---|
| CLM0002789 | 17 Oct 2024 | 619.00 | CASCADE CARE | Not denied | — |
| CLM0002791 | 8 Sep 2024 | 689.00 | CASCADE CARE | Not denied | — |
| CLM0002790 | 7 May 2024 | 248.00 | CASCADE CARE | CARC 27 · ELIGIBILITY | 248.00 |