UMA LOPEZ
Subscriber on policy B08M000115
Claims
1
Attributed to this person
Charged
626.00
Total submitted
Denied
626.00
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 | UMA LOPEZ |
| Role on the policy | Subscriber |
| Policy | B08M000115 |
| Date of birth | 22 Jul 2000 |
| Plan | GOLD PPO |
| Covered from | 6 Apr 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 |
|---|---|---|---|---|---|
| CLM0000499 | 21 Jan 2026 | 626.00 | NORTHSTAR MUTUAL | CARC 18 · DUPLICATE | 626.00 |