MARCUS LOPEZ
Dependent on policy B04M000508
Claims
3
Attributed to this person
Charged
1,255.00
Total submitted
Denied
387.00
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 | MARCUS LOPEZ |
| Role on the policy | Dependent · relationship 01 |
| Policy | B04M000508 |
| Date of birth | 1 Jul 2003 |
| Plan | SILVER HMO |
| Covered from | 9 May 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 |
|---|---|---|---|---|---|
| CLM0002186 | 2 Sep 2025 | 608.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0002187 | 7 May 2025 | 260.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0002188 | 16 Apr 2025 | 387.00 | NORTHSTAR MUTUAL | CARC 26 · ELIGIBILITY | 387.00 |