JULIA LOPEZ
Subscriber on policy B08M000038
Claims
3
Attributed to this person
Charged
753.00
Total submitted
Denied
484.00
2 denied claims
Patient responsibility
122.85
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 | JULIA LOPEZ |
| Role on the policy | Subscriber |
| Policy | B08M000038 |
| Date of birth | 16 Jan 1996 |
| Plan | GOLD PPO |
| Covered from | 16 Jan 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 50 · Other | 1 | 122.85 |
| Total | 122.85 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000161 | 13 Oct 2025 | 80.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0000159 | 30 Jan 2025 | 189.00 | NORTHSTAR MUTUAL | CARC 50 · MEDICAL_NECESSITY | 0.00 |
| CLM0000160 | 25 Dec 2024 | 484.00 | NORTHSTAR MUTUAL | CARC 26 · ELIGIBILITY | 484.00 |