CARLA DIAZ
Dependent on policy B07M000516
Claims
2
Attributed to this person
Charged
469.00
Total submitted
Denied
0.00
1 denied claims
Patient responsibility
53.30
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 | CARLA DIAZ |
| Role on the policy | Dependent · relationship 19 |
| Policy | B07M000516 |
| Date of birth | 22 Aug 1998 |
| Plan | GOLD PPO |
| Covered from | 27 Sep 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 50 · Other | 1 | 53.30 |
| Total | 53.30 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002208 | 11 Dec 2025 | 387.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0002209 | 4 Nov 2025 | 82.00 | NORTHSTAR MUTUAL | CARC 50 · MEDICAL_NECESSITY | 0.00 |