AMARA LOPEZ
Subscriber on policy B09M000237
Claims
2
Attributed to this person
Charged
808.00
Total submitted
Denied
108.00
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 | AMARA LOPEZ |
| Role on the policy | Subscriber |
| Policy | B09M000237 |
| Date of birth | 17 Oct 1957 |
| Plan | PLATINUM PPO |
| Covered from | 21 Jun 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 |
|---|---|---|---|---|---|
| CLM0000970 | 14 Jun 2024 | 700.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0000971 | 25 May 2024 | 108.00 | NORTHSTAR MUTUAL | CARC 26 · ELIGIBILITY | 108.00 |