ELENA LOPEZ
Dependent on policy B05M000879
Claims
1
Attributed to this person
Charged
419.00
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 | ELENA LOPEZ |
| Role on the policy | Dependent · relationship 19 |
| Policy | B05M000879 |
| Date of birth | 5 Sep 1994 |
| Plan | SILVER HMO |
| Covered from | 16 May 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 |
|---|---|---|---|---|---|
| CLM0003732 | 14 Dec 2025 | 419.00 | NORTHSTAR MUTUAL | Not denied | — |