CARLA DIAZ
Subscriber on policy B10M000582
Claims
1
Attributed to this person
Charged
506.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
101.20
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 | CARLA DIAZ |
| Role on the policy | Subscriber |
| Policy | B10M000582 |
| Date of birth | 26 May 1989 |
| Plan | GOLD PPO |
| Covered from | 20 Jun 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 101.20 |
| Total | 101.20 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002411 | 26 Nov 2024 | 506.00 | NORTHSTAR MUTUAL | Not denied | — |