HENRY DIAZ
Dependent on policy B02M000701
Claims
1
Attributed to this person
Charged
80.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
25.00
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 | HENRY DIAZ |
| Role on the policy | Dependent · relationship 01 |
| Policy | B02M000701 |
| Date of birth | 9 Apr 1962 |
| Plan | BRONZE EPO |
| Covered from | 15 Jan 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 3 · Copay | 1 | 25.00 |
| Total | 25.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002954 | 24 Oct 2025 | 80.00 | CASCADE CARE | Not denied | — |