PRIYA LOPEZ
Subscriber on policy B09M000615
Claims
3
Attributed to this person
Charged
1,612.00
Total submitted
Denied
830.00
1 denied claims
Patient responsibility
101.25
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 | PRIYA LOPEZ |
| Role on the policy | Subscriber |
| Policy | B09M000615 |
| Date of birth | 14 May 1982 |
| Plan | GOLD PPO |
| Covered from | 11 Mar 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 101.25 |
| Total | 101.25 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002591 | 14 Apr 2026 | 107.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0002590 | 9 Mar 2026 | 675.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0002592 | 25 Feb 2025 | 830.00 | NORTHSTAR MUTUAL | CARC 26 · ELIGIBILITY | 830.00 |