YUSUF LOPEZ
Subscriber on policy B05M000143
Claims
3
Attributed to this person
Charged
1,476.00
Total submitted
Denied
92.18
1 denied claims
Patient responsibility
30.00
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 | B05M000143 |
| Date of birth | 3 Jun 1952 |
| Plan | GOLD PPO |
| Covered from | 21 Oct 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 3 · Copay | 1 | 30.00 |
| Total | 30.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000584 | 31 Jan 2026 | 378.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0000586 | 4 Dec 2025 | 745.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0000585 | 1 Nov 2025 | 353.00 | NORTHSTAR MUTUAL | CARC 29 · TIMELY_FILING | 92.18 |