UMA LOPEZ
Dependent on policy B03M000020
Claims
2
Attributed to this person
Charged
628.00
Total submitted
Denied
628.00
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 | UMA LOPEZ |
| Role on the policy | Dependent · relationship 01 |
| Policy | B03M000020 |
| Date of birth | 30 Jan 1944 |
| Plan | PLATINUM PPO |
| Covered from | 7 Feb 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 |
|---|---|---|---|---|---|
| CLM0000097 | 1 Mar 2026 | 202.00 | NORTHSTAR MUTUAL | CARC 109 · COB | 202.00 |
| CLM0000096 | 30 Jun 2025 | 426.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 426.00 |