MARCUS DIAZ
Subscriber on policy B02M000495
Claims
3
Attributed to this person
Charged
1,517.00
Total submitted
Denied
680.00
1 denied claims
Patient responsibility
85.35
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 | MARCUS DIAZ |
| Role on the policy | Subscriber |
| Policy | B02M000495 |
| Date of birth | 16 Nov 1960 |
| Plan | BRONZE EPO |
| Covered from | 13 Jan 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 85.35 |
| Total | 85.35 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002108 | 6 Sep 2025 | 569.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0002107 | 28 Jul 2025 | 680.00 | NORTHSTAR MUTUAL | CARC 18 · DUPLICATE | 680.00 |
| CLM0002109 | 10 Jun 2024 | 268.00 | NORTHSTAR MUTUAL | Not denied | — |