SOFIA LOPEZ
Subscriber on policy B09M000473
Claims
2
Attributed to this person
Charged
815.00
Total submitted
Denied
289.00
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 | SOFIA LOPEZ |
| Role on the policy | Subscriber |
| Policy | B09M000473 |
| Date of birth | 24 Dec 1989 |
| Plan | GOLD PPO |
| Covered from | 25 May 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 |
|---|---|---|---|---|---|
| CLM0002003 | 25 Jun 2025 | 289.00 | NORTHSTAR MUTUAL | CARC 29 · TIMELY_FILING | 289.00 |
| CLM0002002 | 23 Jun 2025 | 526.00 | NORTHSTAR MUTUAL | Not denied | — |