YUSUF LOPEZ
Subscriber on policy B08M000150
Claims
3
Attributed to this person
Charged
1,632.00
Total submitted
Denied
915.00
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 | YUSUF LOPEZ |
| Role on the policy | Subscriber |
| Policy | B08M000150 |
| Date of birth | 28 Dec 1951 |
| Plan | SILVER HMO |
| Covered from | 24 Jun 2025 |
| Covered to | 6 Oct 2025 |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000700 | 14 Oct 2025 | 215.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 215.00 |
| CLM0000702 | 14 Sep 2025 | 717.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0000701 | 4 Jun 2025 | 700.00 | NORTHSTAR MUTUAL | CARC 26 · ELIGIBILITY | 700.00 |