CARLA LOPEZ
Dependent on policy B05M000613
Claims
3
Attributed to this person
Charged
1,718.00
Total submitted
Denied
229.96
1 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 | CARLA LOPEZ |
| Role on the policy | Dependent · relationship 01 |
| Policy | B05M000613 |
| Date of birth | 30 Oct 1943 |
| Plan | SILVER HMO |
| Covered from | 8 Jun 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 |
|---|---|---|---|---|---|
| CLM0002633 | 4 Feb 2026 | 711.00 | NORTHSTAR MUTUAL | CARC 11 · CODING | 229.96 |
| CLM0002632 | 31 Jul 2024 | 698.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0002631 | 16 Jul 2024 | 309.00 | NORTHSTAR MUTUAL | Not denied | — |