YUSUF DIAZ
Subscriber on policy B03M000499
Claims
2
Attributed to this person
Charged
859.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
66.60
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 | Subscriber |
| Policy | B03M000499 |
| Date of birth | 9 Oct 2004 |
| Plan | GOLD PPO |
| Covered from | 2 Jan 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 66.60 |
| Total | 66.60 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002068 | 4 Mar 2026 | 526.00 | CASCADE CARE | Not denied | — |
| CLM0002069 | 19 May 2025 | 333.00 | CASCADE CARE | Not denied | — |