MARCUS DIAZ
Subscriber on policy B01M000849
Claims
2
Attributed to this person
Charged
750.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
11.55
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 | MARCUS DIAZ |
| Role on the policy | Subscriber |
| Policy | B01M000849 |
| Date of birth | 14 Feb 1968 |
| Plan | GOLD PPO |
| Covered from | 9 Feb 2025 |
| Covered to | 5 Jun 2025 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 11.55 |
| Total | 11.55 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003762 | 11 May 2025 | 673.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0003763 | 14 Mar 2025 | 77.00 | NORTHSTAR MUTUAL | Not denied | — |