NADIA LOPEZ
Dependent on policy B03M000137
Claims
1
Attributed to this person
Charged
263.00
Total submitted
Denied
52.69
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 | NADIA LOPEZ |
| Role on the policy | Dependent · relationship 01 |
| Policy | B03M000137 |
| Date of birth | 9 Apr 1972 |
| Plan | PLATINUM PPO |
| Covered from | 19 Aug 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 |
|---|---|---|---|---|---|
| CLM0000549 | 30 Sep 2024 | 263.00 | NORTHSTAR MUTUAL | CARC 197 · AUTHORIZATION | 52.69 |