YUSUF DIAZ
Dependent on policy B03M000694
Claims
2
Attributed to this person
Charged
463.00
Total submitted
Denied
0.00
0 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 | YUSUF DIAZ |
| Role on the policy | Dependent · relationship 01 |
| Policy | B03M000694 |
| Date of birth | 3 May 2005 |
| Plan | PLATINUM PPO |
| Covered from | 7 Sep 2024 |
| Covered to | 22 Jun 2025 |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002885 | 15 Nov 2024 | 109.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0002886 | 25 Oct 2024 | 354.00 | NORTHSTAR MUTUAL | Not denied | — |