WENDY LOPEZ
Subscriber on policy B07M000092
Claims
1
Attributed to this person
Charged
212.00
Total submitted
Denied
212.00
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 | WENDY LOPEZ |
| Role on the policy | Subscriber |
| Policy | B07M000092 |
| Date of birth | 26 Dec 1963 |
| Plan | SILVER HMO |
| Covered from | 4 Sep 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 |
|---|---|---|---|---|---|
| CLM0000385 | 16 Nov 2024 | 212.00 | NORTHSTAR MUTUAL | CARC 197 · AUTHORIZATION | 212.00 |