HENRY DIAZ
Subscriber on policy B08M000672
Claims
3
Attributed to this person
Charged
502.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
25.05
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 | B08M000672 |
| Date of birth | 18 Jun 1951 |
| Plan | BRONZE EPO |
| Covered from | 8 Oct 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 25.05 |
| Total | 25.05 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003027 | 30 Apr 2026 | 167.00 | CASCADE CARE | Not denied | — |
| CLM0003029 | 14 Feb 2026 | 62.00 | CASCADE CARE | Not denied | — |
| CLM0003028 | 31 Oct 2024 | 273.00 | CASCADE CARE | Not denied | — |