GRACE LOPEZ
Subscriber on policy B01M000640
Claims
3
Attributed to this person
Charged
1,574.00
Total submitted
Denied
821.00
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 | GRACE LOPEZ |
| Role on the policy | Subscriber |
| Policy | B01M000640 |
| Date of birth | 21 Jul 1959 |
| Plan | PLATINUM PPO |
| Covered from | 6 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 |
|---|---|---|---|---|---|
| CLM0002854 | 26 Apr 2026 | 261.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0002855 | 9 Mar 2026 | 492.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0002856 | 10 Apr 2025 | 821.00 | NORTHSTAR MUTUAL | CARC 26 · ELIGIBILITY | 821.00 |