JULIA LOPEZ
Dependent on policy B01M000126
Claims
1
Attributed to this person
Charged
812.00
Total submitted
Denied
400.32
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 | JULIA LOPEZ |
| Role on the policy | Dependent · relationship 01 |
| Policy | B01M000126 |
| Date of birth | 7 Oct 1975 |
| Plan | BRONZE EPO |
| Covered from | 27 Jan 2024 |
| Covered to | 28 Oct 2024 |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000499 | 12 Jun 2024 | 812.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 400.32 |