AMARA DIAZ
Dependent on policy B05M000676
Claims
2
Attributed to this person
Charged
958.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
177.65
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 | AMARA DIAZ |
| Role on the policy | Dependent · relationship 19 |
| Policy | B05M000676 |
| Date of birth | 9 Mar 2007 |
| Plan | GOLD PPO |
| Covered from | 27 Dec 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 135.80 |
| CARC 1 · Deductible | 1 | 41.85 |
| Total | 177.65 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002915 | 2 Nov 2025 | 679.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0002914 | 5 Jan 2025 | 279.00 | NORTHSTAR MUTUAL | Not denied | — |