VICTOR DIAZ
Dependent on policy B05M000676
Claims
1
Attributed to this person
Charged
313.00
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 | VICTOR DIAZ |
| Role on the policy | Dependent · relationship 01 |
| Policy | B05M000676 |
| Date of birth | 22 Jun 1996 |
| Plan | GOLD PPO |
| Covered from | 27 Dec 2024 |
| 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 |
|---|---|---|---|---|---|
| CLM0002913 | 28 Aug 2026 | 313.00 | NORTHSTAR MUTUAL | Not denied | — |