BRIAN LOPEZ
Subscriber on policy B03M000532
Claims
3
Attributed to this person
Charged
2,307.00
Total submitted
Denied
0.00
0 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 | BRIAN LOPEZ |
| Role on the policy | Subscriber |
| Policy | B03M000532 |
| Date of birth | 12 Dec 1997 |
| Plan | GOLD PPO |
| Covered from | 2 Jun 2025 |
| Covered to | 3 Jan 2026 |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002175 | 20 Sep 2025 | 847.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0002174 | 14 Aug 2025 | 821.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0002176 | 8 Jun 2025 | 639.00 | NORTHSTAR MUTUAL | Not denied | — |