MARCUS LOPEZ
Dependent on policy B06M000037
Claims
2
Attributed to this person
Charged
1,138.00
Total submitted
Denied
419.00
1 denied claims
Patient responsibility
143.80
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 | MARCUS LOPEZ |
| Role on the policy | Dependent · relationship 01 |
| Policy | B06M000037 |
| Date of birth | 21 Jan 1991 |
| Plan | BRONZE EPO |
| Covered from | 6 Feb 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 143.80 |
| Total | 143.80 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000209 | 26 Oct 2025 | 419.00 | CASCADE CARE | CARC 27 · ELIGIBILITY | 419.00 |
| CLM0000208 | 31 Oct 2024 | 719.00 | CASCADE CARE | Not denied | — |