HENRY LOPEZ
Subscriber on policy B08M000466
Claims
3
Attributed to this person
Charged
836.00
Total submitted
Denied
226.00
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 | HENRY LOPEZ |
| Role on the policy | Subscriber |
| Policy | B08M000466 |
| Date of birth | 19 Aug 1981 |
| Plan | SILVER HMO |
| Covered from | 16 Oct 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 |
|---|---|---|---|---|---|
| CLM0002143 | 22 Jul 2025 | 229.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0002144 | 30 Apr 2025 | 381.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0002145 | 1 Feb 2025 | 226.00 | NORTHSTAR MUTUAL | CARC 16 · BILLING_ERROR | 226.00 |