TOMAS LOPEZ
Subscriber on policy B06M000596
Claims
3
Attributed to this person
Charged
564.00
Total submitted
Denied
23.33
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 | TOMAS LOPEZ |
| Role on the policy | Subscriber |
| Policy | B06M000596 |
| Date of birth | 27 Sep 1989 |
| Plan | BRONZE EPO |
| Covered from | 29 Jul 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 |
|---|---|---|---|---|---|
| CLM0002669 | 19 Jul 2026 | 422.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0002670 | 28 Jun 2026 | 75.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0002668 | 31 Jan 2025 | 67.00 | MERIDIAN HEALTH PLAN | CARC 197 · AUTHORIZATION | 23.33 |