SOFIA DIAZ
Dependent on policy B02M000394
Claims
3
Attributed to this person
Charged
1,671.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
30.00
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 | SOFIA DIAZ |
| Role on the policy | Dependent · relationship 19 |
| Policy | B02M000394 |
| Date of birth | 12 Nov 2002 |
| Plan | SILVER HMO |
| Covered from | 2 Mar 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 3 · Copay | 1 | 30.00 |
| Total | 30.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001685 | 21 Aug 2026 | 690.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0001683 | 2 Jul 2025 | 585.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0001684 | 9 May 2024 | 396.00 | NORTHSTAR MUTUAL | Not denied | — |