VICTOR DIAZ
Dependent on policy B05M000720
Claims
3
Attributed to this person
Charged
1,867.00
Total submitted
Denied
866.00
1 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 19 |
| Policy | B05M000720 |
| Date of birth | 1 Dec 2023 |
| Plan | GOLD PPO |
| Covered from | 2 Nov 2024 |
| Covered to | 11 Jun 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 |
|---|---|---|---|---|---|
| CLM0003089 | 5 Jun 2025 | 639.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0003090 | 23 May 2025 | 866.00 | NORTHSTAR MUTUAL | CARC 18 · DUPLICATE | 866.00 |
| CLM0003091 | 1 Dec 2024 | 362.00 | NORTHSTAR MUTUAL | Not denied | — |