HENRY DIAZ
Dependent on policy B04M000777
Claims
3
Attributed to this person
Charged
916.00
Total submitted
Denied
82.00
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 | HENRY DIAZ |
| Role on the policy | Dependent · relationship 01 |
| Policy | B04M000777 |
| Date of birth | 12 Dec 1992 |
| Plan | BRONZE EPO |
| Covered from | 11 Jun 2025 |
| 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 |
|---|---|---|---|---|---|
| CLM0003385 | 23 Jun 2026 | 82.00 | NORTHSTAR MUTUAL | CARC 18 · DUPLICATE | 82.00 |
| CLM0003387 | 10 Aug 2025 | 400.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0003386 | 8 Aug 2025 | 434.00 | NORTHSTAR MUTUAL | Not denied | — |