ZARA LOPEZ
Subscriber on policy B02M000708
Claims
2
Attributed to this person
Charged
1,193.00
Total submitted
Denied
1,193.00
2 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 | ZARA LOPEZ |
| Role on the policy | Subscriber |
| Policy | B02M000708 |
| Date of birth | 23 Jul 2004 |
| Plan | PLATINUM PPO |
| Covered from | 13 Feb 2025 |
| Covered to | 28 Sep 2025 |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002978 | 12 Oct 2025 | 888.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 888.00 |
| CLM0002979 | 2 Feb 2025 | 305.00 | NORTHSTAR MUTUAL | CARC 26 · ELIGIBILITY | 305.00 |