ELENA LOPEZ
Dependent on policy B05M000551
Claims
3
Attributed to this person
Charged
1,714.00
Total submitted
Denied
910.00
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 | ELENA LOPEZ |
| Role on the policy | Dependent · relationship 01 |
| Policy | B05M000551 |
| Date of birth | 23 Oct 1968 |
| Plan | BRONZE EPO |
| Covered from | 14 Apr 2025 |
| 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 |
|---|---|---|---|---|---|
| CLM0002360 | 27 Jan 2026 | 804.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0002361 | 24 Nov 2025 | 198.00 | NORTHSTAR MUTUAL | CARC 197 · AUTHORIZATION | 198.00 |
| CLM0002362 | 11 Sep 2025 | 712.00 | NORTHSTAR MUTUAL | CARC 29 · TIMELY_FILING | 712.00 |