MARCUS LOPEZ
Subscriber on policy B10M000235
Claims
3
Attributed to this person
Charged
1,454.00
Total submitted
Denied
598.00
1 denied claims
Patient responsibility
99.30
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 | MARCUS LOPEZ |
| Role on the policy | Subscriber |
| Policy | B10M000235 |
| Date of birth | 26 Jun 1986 |
| Plan | PLATINUM PPO |
| Covered from | 10 Jan 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 99.30 |
| Total | 99.30 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000969 | 20 Jun 2026 | 194.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0000970 | 5 Jun 2026 | 598.00 | NORTHSTAR MUTUAL | CARC 26 · ELIGIBILITY | 598.00 |
| CLM0000968 | 30 Jul 2025 | 662.00 | NORTHSTAR MUTUAL | Not denied | — |