OMAR DIAZ
Subscriber on policy B08M000228
Claims
3
Attributed to this person
Charged
982.00
Total submitted
Denied
244.74
2 denied claims
Patient responsibility
57.60
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 | OMAR DIAZ |
| Role on the policy | Subscriber |
| Policy | B08M000228 |
| Date of birth | 13 Dec 1992 |
| Plan | PLATINUM PPO |
| Covered from | 27 Apr 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 57.60 |
| Total | 57.60 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001028 | 16 Mar 2025 | 151.00 | CASCADE CARE | CARC 197 · AUTHORIZATION | 151.00 |
| CLM0001027 | 2 Feb 2025 | 384.00 | CASCADE CARE | Not denied | — |
| CLM0001026 | 19 Oct 2024 | 447.00 | CASCADE CARE | CARC 18 · DUPLICATE | 93.74 |