CARLA LOPEZ
Subscriber on policy B06M000563
Claims
2
Attributed to this person
Charged
907.00
Total submitted
Denied
138.00
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 | CARLA LOPEZ |
| Role on the policy | Subscriber |
| Policy | B06M000563 |
| Date of birth | 22 Aug 1994 |
| Plan | GOLD PPO |
| Covered from | 25 May 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 |
|---|---|---|---|---|---|
| CLM0002512 | 29 May 2026 | 769.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0002511 | 9 May 2025 | 138.00 | NORTHSTAR MUTUAL | CARC 26 · ELIGIBILITY | 138.00 |