NADIA DIAZ
Dependent on policy B08M000314
Claims
1
Attributed to this person
Charged
265.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
39.75
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 | NADIA DIAZ |
| Role on the policy | Dependent · relationship 01 |
| Policy | B08M000314 |
| Date of birth | 3 Oct 1963 |
| Plan | BRONZE EPO |
| Covered from | 4 May 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 39.75 |
| Total | 39.75 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001449 | 1 May 2025 | 265.00 | NORTHSTAR MUTUAL | Not denied | — |