IVAN DIAZ
Subscriber on policy B03M000122
Claims
2
Attributed to this person
Charged
915.00
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 | IVAN DIAZ |
| Role on the policy | Subscriber |
| Policy | B03M000122 |
| Date of birth | 24 Apr 1967 |
| Plan | GOLD PPO |
| Covered from | 6 Feb 2025 |
| Covered to | 20 Nov 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 |
|---|---|---|---|---|---|
| CLM0000482 | 19 Apr 2025 | 265.00 | CASCADE CARE | Not denied | — |
| CLM0000483 | 10 Apr 2025 | 650.00 | CASCADE CARE | Not denied | — |