FIONA LOPEZ
Subscriber on policy B05M000068
Claims
3
Attributed to this person
Charged
2,081.00
Total submitted
Denied
1,202.00
2 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 | Subscriber |
| Policy | B05M000068 |
| Date of birth | 29 Oct 1951 |
| Plan | PLATINUM PPO |
| Covered from | 7 Feb 2024 |
| 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 |
|---|---|---|---|---|---|
| CLM0000318 | 28 Feb 2026 | 721.00 | NORTHSTAR MUTUAL | CARC 11 · CODING | 721.00 |
| CLM0000317 | 3 May 2025 | 481.00 | NORTHSTAR MUTUAL | CARC 26 · ELIGIBILITY | 481.00 |
| CLM0000319 | 19 Mar 2024 | 879.00 | NORTHSTAR MUTUAL | Not denied | — |