KEVIN DIAZ
Subscriber on policy B09M000313
Claims
3
Attributed to this person
Charged
1,180.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
20.40
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 | KEVIN DIAZ |
| Role on the policy | Subscriber |
| Policy | B09M000313 |
| Date of birth | 25 Oct 1953 |
| Plan | GOLD PPO |
| Covered from | 7 Mar 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 20.40 |
| Total | 20.40 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001287 | 11 Apr 2025 | 817.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0001286 | 23 May 2024 | 136.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0001288 | 11 Mar 2024 | 227.00 | NORTHSTAR MUTUAL | Not denied | — |