ELENA LOPEZ
Subscriber on policy B06M000227
Claims
3
Attributed to this person
Charged
1,491.00
Total submitted
Denied
0.00
1 denied claims
Patient responsibility
518.70
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 | ELENA LOPEZ |
| Role on the policy | Subscriber |
| Policy | B06M000227 |
| Date of birth | 13 Feb 1958 |
| Plan | BRONZE EPO |
| Covered from | 10 Sep 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 50 · Other | 1 | 518.70 |
| Total | 518.70 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001086 | 29 Jul 2026 | 591.00 | CASCADE CARE | Not denied | — |
| CLM0001084 | 9 Dec 2025 | 102.00 | CASCADE CARE | Not denied | — |
| CLM0001085 | 25 Mar 2025 | 798.00 | CASCADE CARE | CARC 50 · MEDICAL_NECESSITY | 0.00 |