MARCUS LOPEZ
Dependent on policy B05M000143
Claims
2
Attributed to this person
Charged
952.00
Total submitted
Denied
0.00
1 denied claims
Patient responsibility
358.15
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 | B05M000143 |
| Date of birth | 25 Dec 1990 |
| Plan | GOLD PPO |
| Covered from | 21 Oct 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 50 · Other | 1 | 358.15 |
| Total | 358.15 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000590 | 4 Feb 2026 | 401.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0000591 | 28 Sep 2025 | 551.00 | NORTHSTAR MUTUAL | CARC 50 · MEDICAL_NECESSITY | 0.00 |