LEILA DIAZ
Subscriber on policy B10M000755
Claims
2
Attributed to this person
Charged
644.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
56.70
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 | Subscriber |
| Policy | B10M000755 |
| Date of birth | 22 Nov 1957 |
| Plan | BRONZE EPO |
| Covered from | 12 May 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 56.70 |
| Total | 56.70 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003166 | 2 Apr 2025 | 378.00 | CASCADE CARE | Not denied | — |
| CLM0003167 | 4 Aug 2024 | 266.00 | CASCADE CARE | Not denied | — |