UMA LOPEZ
Dependent on policy B09M000841
Claims
3
Attributed to this person
Charged
1,221.00
Total submitted
Denied
214.00
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 | UMA LOPEZ |
| Role on the policy | Dependent · relationship 19 |
| Policy | B09M000841 |
| Date of birth | 7 Apr 1995 |
| Plan | SILVER HMO |
| Covered from | 2 Jul 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 |
|---|---|---|---|---|---|
| CLM0003582 | 29 Sep 2025 | 703.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0003581 | 18 Dec 2024 | 304.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0003580 | 13 Jun 2024 | 214.00 | NORTHSTAR MUTUAL | CARC 26 · ELIGIBILITY | 214.00 |