RAVI DIAZ
Dependent on policy B08M000467
Claims
3
Attributed to this person
Charged
1,784.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
60.80
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 | RAVI DIAZ |
| Role on the policy | Dependent · relationship 01 |
| Policy | B08M000467 |
| Date of birth | 18 Jan 1999 |
| Plan | GOLD PPO |
| Covered from | 22 Mar 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 60.80 |
| Total | 60.80 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002156 | 1 Aug 2026 | 842.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0002155 | 18 Apr 2026 | 304.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0002154 | 17 Jun 2025 | 638.00 | NORTHSTAR MUTUAL | Not denied | — |