OMAR DIAZ
Dependent on policy B10M000248
Claims
3
Attributed to this person
Charged
2,381.00
Total submitted
Denied
887.00
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 19 |
| Policy | B10M000248 |
| Date of birth | 29 Jul 2021 |
| Plan | GOLD PPO |
| Covered from | 14 Dec 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 |
|---|---|---|---|---|---|
| CLM0001024 | 8 Aug 2026 | 878.00 | CASCADE CARE | Not denied | — |
| CLM0001025 | 15 Nov 2025 | 616.00 | CASCADE CARE | Not denied | — |
| CLM0001026 | 9 Dec 2024 | 887.00 | CASCADE CARE | CARC 26 · ELIGIBILITY | 887.00 |