ZARA LOPEZ
Dependent on policy B06M000355
Claims
3
Attributed to this person
Charged
450.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
20.00
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 | ZARA LOPEZ |
| Role on the policy | Dependent · relationship 01 |
| Policy | B06M000355 |
| Date of birth | 1 Oct 1984 |
| Plan | SILVER HMO |
| Covered from | 23 Sep 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 20.00 |
| Total | 20.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001611 | 6 Jun 2026 | 81.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0001612 | 26 Jan 2026 | 269.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0001610 | 5 Oct 2025 | 100.00 | NORTHSTAR MUTUAL | Not denied | — |