MARCUS LOPEZ
Dependent on policy B03M000064
Claims
1
Attributed to this person
Charged
490.00
Total submitted
Denied
490.00
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 | MARCUS LOPEZ |
| Role on the policy | Dependent · relationship 01 |
| Policy | B03M000064 |
| Date of birth | 13 Sep 2004 |
| Plan | BRONZE EPO |
| Covered from | 10 Oct 2024 |
| 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 |
|---|---|---|---|---|---|
| CLM0000276 | 15 Jun 2026 | 490.00 | NORTHSTAR MUTUAL | CARC 16 · BILLING_ERROR | 490.00 |