LEILA DIAZ
Dependent on policy B03M000669
Claims
3
Attributed to this person
Charged
931.00
Total submitted
Denied
209.00
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 | Dependent · relationship 19 |
| Policy | B03M000669 |
| Date of birth | 16 Feb 2012 |
| Plan | SILVER HMO |
| Covered from | 14 Jan 2025 |
| 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 |
|---|---|---|---|---|---|
| CLM0002774 | 30 Jun 2025 | 343.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0002775 | 2 Apr 2025 | 379.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0002773 | 31 Mar 2025 | 209.00 | NORTHSTAR MUTUAL | CARC 18 · DUPLICATE | 209.00 |