KEVIN DIAZ
Subscriber on policy B03M000541
Claims
1
Attributed to this person
Charged
877.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
50.00
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 | KEVIN DIAZ |
| Role on the policy | Subscriber |
| Policy | B03M000541 |
| Date of birth | 6 Jun 1962 |
| Plan | PLATINUM PPO |
| Covered from | 6 Oct 2024 |
| Covered to | 11 Jan 2025 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 3 · Copay | 1 | 50.00 |
| Total | 50.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002227 | 11 Dec 2024 | 877.00 | NORTHSTAR MUTUAL | Not denied | — |