PRIYA LOPEZ
Subscriber on policy B10M000501
Claims
2
Attributed to this person
Charged
989.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
45.00
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 | PRIYA LOPEZ |
| Role on the policy | Subscriber |
| Policy | B10M000501 |
| Date of birth | 27 Mar 1984 |
| Plan | GOLD PPO |
| Covered from | 24 Apr 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 45.00 |
| Total | 45.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002063 | 3 Jun 2026 | 689.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0002062 | 27 Apr 2026 | 300.00 | NORTHSTAR MUTUAL | Not denied | — |