LEILA DIAZ
Dependent on policy B09M000689
Claims
2
Attributed to this person
Charged
806.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
99.00
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 | LEILA DIAZ |
| Role on the policy | Dependent · relationship 01 |
| Policy | B09M000689 |
| Date of birth | 20 Jul 2010 |
| Plan | GOLD PPO |
| Covered from | 23 Jan 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 99.00 |
| Total | 99.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002940 | 27 Jun 2025 | 660.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0002939 | 24 Apr 2025 | 146.00 | NORTHSTAR MUTUAL | Not denied | — |