YUSUF LOPEZ
Subscriber on policy B04M000515
Claims
3
Attributed to this person
Charged
2,108.00
Total submitted
Denied
751.00
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 | YUSUF LOPEZ |
| Role on the policy | Subscriber |
| Policy | B04M000515 |
| Date of birth | 30 Jan 1974 |
| Plan | PLATINUM PPO |
| Covered from | 12 Dec 2024 |
| Covered to | 19 Aug 2025 |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002223 | 27 Jun 2025 | 632.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0002224 | 9 Jun 2025 | 751.00 | NORTHSTAR MUTUAL | CARC 18 · DUPLICATE | 751.00 |
| CLM0002222 | 20 Apr 2025 | 725.00 | NORTHSTAR MUTUAL | Not denied | — |