HENRY LOPEZ
Dependent on policy B09M000615
Claims
3
Attributed to this person
Charged
1,955.00
Total submitted
Denied
823.00
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 | HENRY LOPEZ |
| Role on the policy | Dependent · relationship 01 |
| Policy | B09M000615 |
| Date of birth | 6 Jul 1973 |
| Plan | GOLD PPO |
| Covered from | 11 Mar 2025 |
| 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 |
|---|---|---|---|---|---|
| CLM0002593 | 26 May 2026 | 823.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 823.00 |
| CLM0002594 | 22 Sep 2025 | 409.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0002595 | 5 May 2025 | 723.00 | NORTHSTAR MUTUAL | Not denied | — |