IVAN DIAZ
Dependent on policy B01M000411
Claims
3
Attributed to this person
Charged
1,996.00
Total submitted
Denied
487.00
1 denied claims
Patient responsibility
125.60
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 | IVAN DIAZ |
| Role on the policy | Dependent · relationship 19 |
| Policy | B01M000411 |
| Date of birth | 17 Nov 2007 |
| Plan | GOLD PPO |
| Covered from | 5 Dec 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 125.60 |
| Total | 125.60 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001824 | 23 Apr 2025 | 628.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0001825 | 2 Apr 2025 | 487.00 | NORTHSTAR MUTUAL | CARC 50 · MEDICAL_NECESSITY | 487.00 |
| CLM0001823 | 17 Dec 2024 | 881.00 | NORTHSTAR MUTUAL | Not denied | — |