RAVI LOPEZ
Dependent on policy B02M000482
Claims
2
Attributed to this person
Charged
881.00
Total submitted
Denied
492.00
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 | RAVI LOPEZ |
| Role on the policy | Dependent · relationship 19 |
| Policy | B02M000482 |
| Date of birth | 17 Feb 2018 |
| Plan | SILVER HMO |
| Covered from | 24 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 |
|---|---|---|---|---|---|
| CLM0002054 | 1 Aug 2026 | 492.00 | NORTHSTAR MUTUAL | CARC 109 · COB | 492.00 |
| CLM0002053 | 18 Dec 2025 | 389.00 | NORTHSTAR MUTUAL | Not denied | — |