KEVIN LOPEZ
Subscriber on policy B04M000069
Claims
3
Attributed to this person
Charged
1,269.00
Total submitted
Denied
333.24
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 | KEVIN LOPEZ |
| Role on the policy | Subscriber |
| Policy | B04M000069 |
| Date of birth | 4 Oct 1955 |
| Plan | PLATINUM PPO |
| Covered from | 12 Sep 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 |
|---|---|---|---|---|---|
| CLM0000316 | 22 Sep 2025 | 94.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0000317 | 3 Feb 2025 | 420.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0000315 | 21 Oct 2024 | 755.00 | NORTHSTAR MUTUAL | CARC 29 · TIMELY_FILING | 333.24 |