LEILA DIAZ
Subscriber on policy B02M000047
Claims
2
Attributed to this person
Charged
1,179.00
Total submitted
Denied
811.00
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 | LEILA DIAZ |
| Role on the policy | Subscriber |
| Policy | B02M000047 |
| Date of birth | 24 Jun 1967 |
| Plan | SILVER HMO |
| Covered from | 28 Sep 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 |
|---|---|---|---|---|---|
| CLM0000227 | 22 Feb 2026 | 368.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0000225 | 15 Sep 2024 | 811.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 811.00 |