TOMAS DIAZ
Dependent on policy B05M000391
Claims
3
Attributed to this person
Charged
1,794.00
Total submitted
Denied
1,347.00
2 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 | TOMAS DIAZ |
| Role on the policy | Dependent · relationship 01 |
| Policy | B05M000391 |
| Date of birth | 8 Nov 1961 |
| Plan | PLATINUM PPO |
| Covered from | 6 Feb 2025 |
| Covered to | 21 Sep 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 |
|---|---|---|---|---|---|
| CLM0001676 | 18 Oct 2025 | 850.00 | CASCADE CARE | CARC 26 · ELIGIBILITY | 850.00 |
| CLM0001674 | 24 Aug 2025 | 447.00 | CASCADE CARE | Not denied | — |
| CLM0001675 | 13 Jan 2025 | 497.00 | CASCADE CARE | CARC 26 · ELIGIBILITY | 497.00 |