GRACE DIAZ
Dependent on policy B04M000039
Claims
1
Attributed to this person
Charged
287.00
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 | GRACE DIAZ |
| Role on the policy | Dependent · relationship 01 |
| Policy | B04M000039 |
| Date of birth | 21 Jan 1993 |
| 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 |
|---|---|---|---|---|---|
| CLM0000184 | 18 Dec 2024 | 287.00 | CASCADE CARE | Not denied | — |