AMARA LOPEZ
Dependent on policy B01M000536
Claims
2
Attributed to this person
Charged
722.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
34.80
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 | AMARA LOPEZ |
| Role on the policy | Dependent · relationship 19 |
| Policy | B01M000536 |
| Date of birth | 14 Sep 2003 |
| Plan | PLATINUM PPO |
| Covered from | 16 Jan 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 34.80 |
| Total | 34.80 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002409 | 23 Jul 2026 | 490.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0002408 | 10 Jan 2025 | 232.00 | NORTHSTAR MUTUAL | Not denied | — |