AMARA LOPEZ
Dependent on policy B06M000871
Claims
3
Attributed to this person
Charged
1,306.00
Total submitted
Denied
692.33
2 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 | AMARA LOPEZ |
| Role on the policy | Dependent · relationship 01 |
| Policy | B06M000871 |
| Date of birth | 19 Mar 1990 |
| Plan | GOLD PPO |
| Covered from | 14 Jan 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 |
|---|---|---|---|---|---|
| CLM0003800 | 17 Jul 2026 | 684.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 684.00 |
| CLM0003798 | 18 Nov 2025 | 85.00 | NORTHSTAR MUTUAL | CARC 11 · CODING | 8.33 |
| CLM0003799 | 3 Aug 2025 | 537.00 | NORTHSTAR MUTUAL | Not denied | — |