HENRY DIAZ
Dependent on policy B05M000145
Claims
2
Attributed to this person
Charged
1,215.00
Total submitted
Denied
801.00
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 | HENRY DIAZ |
| Role on the policy | Dependent · relationship 19 |
| Policy | B05M000145 |
| Date of birth | 28 Dec 1991 |
| Plan | SILVER HMO |
| Covered from | 24 Aug 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 |
|---|---|---|---|---|---|
| CLM0000603 | 23 Sep 2024 | 414.00 | CASCADE CARE | Not denied | — |
| CLM0000604 | 25 Jul 2024 | 801.00 | CASCADE CARE | CARC 26 · ELIGIBILITY | 801.00 |