CARLA LOPEZ
Subscriber on policy B08M000695
Claims
1
Attributed to this person
Charged
559.00
Total submitted
Denied
559.00
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 | CARLA LOPEZ |
| Role on the policy | Subscriber |
| Policy | B08M000695 |
| Date of birth | 4 Feb 1958 |
| Plan | GOLD PPO |
| Covered from | 14 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 |
|---|---|---|---|---|---|
| CLM0003136 | 3 Aug 2026 | 559.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 559.00 |