FIONA LOPEZ
Dependent on policy B07M000423
Claims
2
Attributed to this person
Charged
1,185.00
Total submitted
Denied
370.01
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 | FIONA LOPEZ |
| Role on the policy | Dependent · relationship 19 |
| Policy | B07M000423 |
| Date of birth | 10 Sep 2005 |
| Plan | GOLD PPO |
| Covered from | 30 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 |
|---|---|---|---|---|---|
| CLM0001788 | 4 Apr 2026 | 691.00 | NORTHSTAR MUTUAL | CARC 96 · NON_COVERED | 242.43 |
| CLM0001789 | 30 Nov 2025 | 494.00 | NORTHSTAR MUTUAL | CARC 96 · NON_COVERED | 127.58 |