BRIAN LOPEZ
Dependent on policy B08M000466
Claims
3
Attributed to this person
Charged
1,162.00
Total submitted
Denied
747.00
1 denied claims
Patient responsibility
20.00
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 | BRIAN LOPEZ |
| Role on the policy | Dependent · relationship 01 |
| Policy | B08M000466 |
| Date of birth | 22 May 1991 |
| Plan | SILVER HMO |
| Covered from | 16 Oct 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 3 · Copay | 1 | 20.00 |
| Total | 20.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002148 | 16 Mar 2026 | 166.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0002146 | 13 Jul 2025 | 249.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0002147 | 1 Feb 2025 | 747.00 | NORTHSTAR MUTUAL | CARC 29 · TIMELY_FILING | 747.00 |