HENRY DIAZ
Subscriber on policy B01M000071
Claims
3
Attributed to this person
Charged
1,775.00
Total submitted
Denied
909.00
2 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 | HENRY DIAZ |
| Role on the policy | Subscriber |
| Policy | B01M000071 |
| Date of birth | 7 Aug 1954 |
| Plan | PLATINUM PPO |
| Covered from | 26 Aug 2024 |
| Covered to | 1 Jan 2025 |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000301 | 17 Feb 2025 | 866.00 | CASCADE CARE | Not denied | — |
| CLM0000299 | 9 Feb 2025 | 628.00 | CASCADE CARE | CARC 26 · ELIGIBILITY | 628.00 |
| CLM0000300 | 12 Jan 2025 | 281.00 | CASCADE CARE | CARC 27 · ELIGIBILITY | 281.00 |