CARLA LOPEZ
Subscriber on policy B06M000399
Claims
3
Attributed to this person
Charged
1,274.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
50.55
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 | CARLA LOPEZ |
| Role on the policy | Subscriber |
| Policy | B06M000399 |
| Date of birth | 17 Aug 1998 |
| Plan | SILVER HMO |
| Covered from | 31 Dec 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 50.55 |
| Total | 50.55 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001816 | 11 Apr 2026 | 337.00 | CASCADE CARE | Not denied | — |
| CLM0001815 | 31 Mar 2026 | 615.00 | CASCADE CARE | Not denied | — |
| CLM0001817 | 19 Oct 2025 | 322.00 | CASCADE CARE | Not denied | — |