BRIAN LOPEZ
Subscriber on policy B04M000063
Claims
2
Attributed to this person
Charged
828.00
Total submitted
Denied
743.00
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 | BRIAN LOPEZ |
| Role on the policy | Subscriber |
| Policy | B04M000063 |
| Date of birth | 30 Apr 1950 |
| Plan | BRONZE EPO |
| Covered from | 20 Mar 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 |
|---|---|---|---|---|---|
| CLM0000275 | 28 May 2026 | 85.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0000276 | 23 Jun 2025 | 743.00 | NORTHSTAR MUTUAL | CARC 29 · TIMELY_FILING | 743.00 |