LEILA LOPEZ
Dependent on policy B05M000783
Claims
3
Attributed to this person
Charged
2,243.00
Total submitted
Denied
0.00
0 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 | Dependent · relationship 01 |
| Policy | B05M000783 |
| Date of birth | 17 Jun 1998 |
| Plan | BRONZE EPO |
| Covered from | 5 Apr 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 |
|---|---|---|---|---|---|
| CLM0003334 | 27 Dec 2025 | 670.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0003333 | 3 Dec 2024 | 849.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0003335 | 7 Aug 2024 | 724.00 | NORTHSTAR MUTUAL | Not denied | — |