OMAR DIAZ
Dependent on policy B09M000875
Claims
2
Attributed to this person
Charged
982.00
Total submitted
Denied
339.00
1 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 | OMAR DIAZ |
| Role on the policy | Dependent · relationship 01 |
| Policy | B09M000875 |
| Date of birth | 26 May 1956 |
| Plan | PLATINUM PPO |
| Covered from | 12 Jan 2025 |
| Covered to | 19 Jun 2025 |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003712 | 30 Apr 2025 | 643.00 | CASCADE CARE | Not denied | — |
| CLM0003713 | 23 Dec 2024 | 339.00 | CASCADE CARE | CARC 26 · ELIGIBILITY | 339.00 |