MARCUS LOPEZ
Dependent on policy B06M000405
Claims
3
Attributed to this person
Charged
1,125.00
Total submitted
Denied
350.00
1 denied claims
Patient responsibility
21.60
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 19 |
| Policy | B06M000405 |
| Date of birth | 18 Nov 2018 |
| Plan | SILVER HMO |
| Covered from | 10 Apr 2025 |
| Covered to | 14 Dec 2025 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 21.60 |
| Total | 21.60 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001845 | 9 Dec 2025 | 144.00 | CASCADE CARE | Not denied | — |
| CLM0001847 | 31 Aug 2025 | 350.00 | CASCADE CARE | CARC 16 · BILLING_ERROR | 350.00 |
| CLM0001846 | 11 Apr 2025 | 631.00 | CASCADE CARE | Not denied | — |