HENRY DIAZ
Dependent on policy B07M000511
Claims
2
Attributed to this person
Charged
1,516.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
111.60
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 | Dependent · relationship 01 |
| Policy | B07M000511 |
| Date of birth | 19 Dec 1995 |
| Plan | PLATINUM PPO |
| Covered from | 30 Mar 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 111.60 |
| Total | 111.60 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002177 | 28 Apr 2026 | 744.00 | CASCADE CARE | Not denied | — |
| CLM0002176 | 21 Apr 2026 | 772.00 | CASCADE CARE | Not denied | — |