RAVI LOPEZ
Dependent on policy B06M000186
Claims
3
Attributed to this person
Charged
1,192.00
Total submitted
Denied
463.00
1 denied claims
Patient responsibility
109.35
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 | RAVI LOPEZ |
| Role on the policy | Dependent · relationship 01 |
| Policy | B06M000186 |
| Date of birth | 6 Jun 1998 |
| Plan | SILVER HMO |
| Covered from | 13 Nov 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 2 | 109.35 |
| Total | 109.35 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000898 | 13 Aug 2026 | 477.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0000900 | 19 Feb 2026 | 463.00 | NORTHSTAR MUTUAL | CARC 16 · BILLING_ERROR | 463.00 |
| CLM0000899 | 17 Jan 2026 | 252.00 | NORTHSTAR MUTUAL | Not denied | — |