LEILA DIAZ
Subscriber on policy B03M000831
Claims
1
Attributed to this person
Charged
164.00
Total submitted
Denied
34.07
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 | Subscriber |
| Policy | B03M000831 |
| Date of birth | 13 Mar 2003 |
| Plan | SILVER HMO |
| Covered from | 27 Jul 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 |
|---|---|---|---|---|---|
| CLM0003586 | 14 Nov 2024 | 164.00 | CASCADE CARE | CARC 29 · TIMELY_FILING | 34.07 |