FIONA LOPEZ
Subscriber on policy B06M000562
Claims
2
Attributed to this person
Charged
1,569.00
Total submitted
Denied
891.00
1 denied claims
Patient responsibility
101.70
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 | FIONA LOPEZ |
| Role on the policy | Subscriber |
| Policy | B06M000562 |
| Date of birth | 9 Jan 1980 |
| Plan | PLATINUM PPO |
| Covered from | 12 Dec 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 101.70 |
| Total | 101.70 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002508 | 10 Jul 2026 | 891.00 | MERIDIAN HEALTH PLAN | CARC 27 · ELIGIBILITY | 891.00 |
| CLM0002507 | 10 Jan 2026 | 678.00 | MERIDIAN HEALTH PLAN | Not denied | — |