KEVIN LOPEZ
Dependent on policy B03M000532
Claims
3
Attributed to this person
Charged
1,600.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
101.55
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 | KEVIN LOPEZ |
| Role on the policy | Dependent · relationship 01 |
| Policy | B03M000532 |
| Date of birth | 5 Jul 1996 |
| Plan | GOLD PPO |
| Covered from | 2 Jun 2025 |
| Covered to | 3 Jan 2026 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 101.55 |
| Total | 101.55 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002178 | 16 Jan 2026 | 677.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0002179 | 17 Oct 2025 | 273.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0002177 | 29 Jul 2025 | 650.00 | NORTHSTAR MUTUAL | Not denied | — |