PRIYA DIAZ
Subscriber on policy B05M000213
Claims
1
Attributed to this person
Charged
270.00
Total submitted
Denied
270.00
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 | PRIYA DIAZ |
| Role on the policy | Subscriber |
| Policy | B05M000213 |
| Date of birth | 14 Dec 1982 |
| Plan | GOLD PPO |
| Covered from | 3 May 2024 |
| Covered to | 31 Jan 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 |
|---|---|---|---|---|---|
| CLM0000884 | 12 Oct 2024 | 270.00 | CASCADE CARE | CARC 197 · AUTHORIZATION | 270.00 |