IVAN DIAZ
Dependent on policy B03M000766
Claims
3
Attributed to this person
Charged
1,419.00
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 | Dependent · relationship 19 |
| Policy | B03M000766 |
| Date of birth | 19 Feb 2019 |
| Plan | PLATINUM PPO |
| Covered from | 6 Jan 2024 |
| 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 |
|---|---|---|---|---|---|
| CLM0003228 | 16 Aug 2024 | 126.00 | CASCADE CARE | Not denied | — |
| CLM0003227 | 30 Jun 2024 | 563.00 | CASCADE CARE | Not denied | — |
| CLM0003226 | 28 Feb 2024 | 730.00 | CASCADE CARE | Not denied | — |