MARCUS LOPEZ
Dependent on policy B04M000515
Claims
1
Attributed to this person
Charged
270.00
Total submitted
Denied
0.00
0 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 19 |
| Policy | B04M000515 |
| Date of birth | 29 May 2010 |
| 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 |
|---|---|---|---|---|---|
| CLM0002228 | 22 Mar 2025 | 270.00 | NORTHSTAR MUTUAL | Not denied | — |