LEILA LOPEZ
Subscriber on policy B09M000623
Claims
1
Attributed to this person
Charged
86.00
Total submitted
Denied
0.00
0 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 | LEILA LOPEZ |
| Role on the policy | Subscriber |
| Policy | B09M000623 |
| Date of birth | 9 Oct 1961 |
| Plan | BRONZE EPO |
| Covered from | 7 Feb 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 |
|---|---|---|---|---|---|
| CLM0002627 | 27 Apr 2025 | 86.00 | NORTHSTAR MUTUAL | Not denied | — |