DAVID LOPEZ
Subscriber on policy B03M000680
Claims
2
Attributed to this person
Charged
856.00
Total submitted
Denied
856.00
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 | DAVID LOPEZ |
| Role on the policy | Subscriber |
| Policy | B03M000680 |
| Date of birth | 9 Sep 2001 |
| Plan | SILVER HMO |
| Covered from | 7 Jun 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 |
|---|---|---|---|---|---|
| CLM0002828 | 20 Jul 2026 | 639.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 639.00 |
| CLM0002827 | 13 May 2025 | 217.00 | NORTHSTAR MUTUAL | CARC 26 · ELIGIBILITY | 217.00 |