GRACE LOPEZ
Subscriber on policy B06M000781
Claims
3
Attributed to this person
Charged
1,532.00
Total submitted
Denied
983.38
3 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 | GRACE LOPEZ |
| Role on the policy | Subscriber |
| Policy | B06M000781 |
| Date of birth | 15 Dec 1964 |
| Plan | SILVER HMO |
| Covered from | 4 Apr 2024 |
| 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 |
|---|---|---|---|---|---|
| CLM0003442 | 15 Mar 2026 | 338.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 127.22 |
| CLM0003441 | 3 Dec 2024 | 427.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 89.16 |
| CLM0003443 | 13 Jul 2024 | 767.00 | NORTHSTAR MUTUAL | CARC 11 · CODING | 767.00 |