HENRY DIAZ
Subscriber on policy B09M000768
Claims
1
Attributed to this person
Charged
853.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
0.00
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 | HENRY DIAZ |
| Role on the policy | Subscriber |
| Policy | B09M000768 |
| Date of birth | 5 May 1996 |
| Plan | PLATINUM PPO |
| Covered from | 17 Apr 2024 |
| Covered to | open |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003249 | 14 May 2024 | 853.00 | CASCADE CARE | Not denied | — |