ELENA LOPEZ
Dependent on policy B04M000503
Claims
2
Attributed to this person
Charged
550.00
Total submitted
Denied
10.74
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 | ELENA LOPEZ |
| Role on the policy | Dependent · relationship 19 |
| Policy | B04M000503 |
| Date of birth | 9 Sep 2007 |
| Plan | SILVER HMO |
| Covered from | 29 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 |
|---|---|---|---|---|---|
| CLM0002164 | 1 Nov 2024 | 187.00 | NORTHSTAR MUTUAL | CARC 16 · BILLING_ERROR | 10.74 |
| CLM0002165 | 19 Jul 2024 | 363.00 | NORTHSTAR MUTUAL | Not denied | — |