FIONA LOPEZ
Dependent on policy B04M000515
Claims
3
Attributed to this person
Charged
1,047.00
Total submitted
Denied
527.00
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 | FIONA LOPEZ |
| Role on the policy | Dependent · relationship 01 |
| Policy | B04M000515 |
| Date of birth | 25 Jan 1980 |
| 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 |
|---|---|---|---|---|---|
| CLM0002227 | 6 Jul 2025 | 306.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0002226 | 23 Jun 2025 | 214.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0002225 | 9 Dec 2024 | 527.00 | NORTHSTAR MUTUAL | CARC 26 · ELIGIBILITY | 527.00 |