HENRY DIAZ
Dependent on policy B04M000039
Claims
1
Attributed to this person
Charged
280.00
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 | HENRY DIAZ |
| Role on the policy | Dependent · relationship 19 |
| Policy | B04M000039 |
| Date of birth | 19 Nov 2011 |
| 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 |
|---|---|---|---|---|---|
| CLM0000187 | 16 Nov 2024 | 280.00 | CASCADE CARE | Not denied | — |