LEILA LOPEZ
Subscriber on policy B06M000064
Claims
2
Attributed to this person
Charged
367.00
Total submitted
Denied
181.00
1 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 | LEILA LOPEZ |
| Role on the policy | Subscriber |
| Policy | B06M000064 |
| Date of birth | 16 Sep 1987 |
| Plan | SILVER HMO |
| Covered from | 4 Feb 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 |
|---|---|---|---|---|---|
| CLM0000348 | 27 Mar 2026 | 181.00 | NORTHSTAR MUTUAL | CARC 29 · TIMELY_FILING | 181.00 |
| CLM0000347 | 2 May 2025 | 186.00 | NORTHSTAR MUTUAL | Not denied | — |