OMAR DIAZ
Subscriber on policy B05M000377
Claims
3
Attributed to this person
Charged
1,208.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
112.80
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 | OMAR DIAZ |
| Role on the policy | Subscriber |
| Policy | B05M000377 |
| Date of birth | 4 Nov 1966 |
| Plan | PLATINUM PPO |
| Covered from | 30 Dec 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 112.80 |
| Total | 112.80 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001601 | 3 May 2026 | 370.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0001600 | 3 Apr 2025 | 752.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0001599 | 19 Mar 2025 | 86.00 | NORTHSTAR MUTUAL | Not denied | — |