PRIYA DIAZ
Subscriber on policy B09M000689
Claims
1
Attributed to this person
Charged
484.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
96.80
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 | PRIYA DIAZ |
| Role on the policy | Subscriber |
| Policy | B09M000689 |
| Date of birth | 9 Jan 2003 |
| Plan | GOLD PPO |
| Covered from | 23 Jan 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 96.80 |
| Total | 96.80 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002938 | 26 Aug 2025 | 484.00 | NORTHSTAR MUTUAL | Not denied | — |