OMAR LOPEZ
Dependent on policy B02M000359
Claims
1
Attributed to this person
Charged
686.00
Total submitted
Denied
686.00
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 | OMAR LOPEZ |
| Role on the policy | Dependent · relationship 19 |
| Policy | B02M000359 |
| Date of birth | 27 Apr 2002 |
| Plan | SILVER HMO |
| Covered from | 31 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 |
|---|---|---|---|---|---|
| CLM0001543 | 5 Aug 2025 | 686.00 | NORTHSTAR MUTUAL | CARC 50 · MEDICAL_NECESSITY | 686.00 |