YUSUF LOPEZ
Subscriber on policy B04M000763
Claims
3
Attributed to this person
Charged
1,547.00
Total submitted
Denied
636.00
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 | B04M000763 |
| Date of birth | 18 Oct 1952 |
| Plan | SILVER HMO |
| Covered from | 19 Jun 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 |
|---|---|---|---|---|---|
| CLM0003320 | 26 Jun 2026 | 636.00 | NORTHSTAR MUTUAL | CARC 197 · AUTHORIZATION | 636.00 |
| CLM0003321 | 6 May 2026 | 654.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0003322 | 2 Feb 2026 | 257.00 | NORTHSTAR MUTUAL | Not denied | — |