TOMAS DIAZ
Dependent on policy B05M000632
Claims
3
Attributed to this person
Charged
1,795.00
Total submitted
Denied
830.84
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 | B05M000632 |
| Date of birth | 30 Jan 1974 |
| Plan | BRONZE EPO |
| Covered from | 29 Mar 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 |
|---|---|---|---|---|---|
| CLM0002723 | 3 May 2026 | 653.00 | CASCADE CARE | CARC 27 · ELIGIBILITY | 653.00 |
| CLM0002722 | 27 Dec 2024 | 512.00 | CASCADE CARE | Not denied | — |
| CLM0002724 | 30 Aug 2024 | 630.00 | CASCADE CARE | CARC 16 · BILLING_ERROR | 177.84 |