AMARA LOPEZ
Dependent on policy B05M000177
Claims
3
Attributed to this person
Charged
907.00
Total submitted
Denied
294.00
2 denied claims
Patient responsibility
354.90
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 | AMARA LOPEZ |
| Role on the policy | Dependent · relationship 01 |
| Policy | B05M000177 |
| Date of birth | 6 Jul 1952 |
| Plan | SILVER HMO |
| Covered from | 25 Jan 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 50 · Other | 1 | 354.90 |
| Total | 354.90 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000744 | 27 May 2026 | 294.00 | NORTHSTAR MUTUAL | CARC 18 · DUPLICATE | 294.00 |
| CLM0000742 | 19 Mar 2026 | 67.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0000743 | 11 Mar 2025 | 546.00 | NORTHSTAR MUTUAL | CARC 50 · MEDICAL_NECESSITY | 0.00 |