HENRY DIAZ
Subscriber on policy B04M000039
Claims
3
Attributed to this person
Charged
1,791.00
Total submitted
Denied
1,678.00
2 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 | Subscriber |
| Policy | B04M000039 |
| Date of birth | 24 Jun 1996 |
| Plan | SILVER HMO |
| Covered from | 12 Dec 2024 |
| Covered to | 18 Jul 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 |
|---|---|---|---|---|---|
| CLM0000183 | 9 Sep 2025 | 855.00 | CASCADE CARE | CARC 27 · ELIGIBILITY | 855.00 |
| CLM0000182 | 19 May 2025 | 113.00 | CASCADE CARE | Not denied | — |
| CLM0000181 | 5 Dec 2024 | 823.00 | CASCADE CARE | CARC 26 · ELIGIBILITY | 823.00 |