WENDY DIAZ
Dependent on policy B09M000313
Claims
2
Attributed to this person
Charged
1,008.00
Total submitted
Denied
652.00
1 denied claims
Patient responsibility
71.20
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 | WENDY DIAZ |
| Role on the policy | Dependent · relationship 19 |
| Policy | B09M000313 |
| Date of birth | 4 May 1982 |
| Plan | GOLD PPO |
| Covered from | 7 Mar 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 71.20 |
| Total | 71.20 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001291 | 15 Jan 2025 | 356.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0001292 | 19 Jul 2024 | 652.00 | NORTHSTAR MUTUAL | CARC 11 · CODING | 652.00 |