LEILA LOPEZ
Subscriber on policy B05M000721
Claims
1
Attributed to this person
Charged
273.00
Total submitted
Denied
273.00
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 | LEILA LOPEZ |
| Role on the policy | Subscriber |
| Policy | B05M000721 |
| Date of birth | 22 May 1986 |
| Plan | BRONZE EPO |
| Covered from | 13 Feb 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 |
|---|---|---|---|---|---|
| CLM0003092 | 27 Jan 2025 | 273.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 273.00 |