VICTOR LOPEZ
Subscriber on policy B01M000536
Claims
3
Attributed to this person
Charged
1,187.00
Total submitted
Denied
348.22
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 | VICTOR LOPEZ |
| Role on the policy | Subscriber |
| Policy | B01M000536 |
| Date of birth | 20 May 1976 |
| Plan | PLATINUM PPO |
| Covered from | 16 Jan 2025 |
| 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 |
|---|---|---|---|---|---|
| CLM0002403 | 2 Jul 2026 | 320.00 | NORTHSTAR MUTUAL | CARC 197 · AUTHORIZATION | 320.00 |
| CLM0002404 | 15 May 2026 | 783.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0002402 | 26 Jul 2025 | 84.00 | NORTHSTAR MUTUAL | CARC 11 · CODING | 28.22 |