GRACE LOPEZ
Subscriber on policy B06M000406
Claims
2
Attributed to this person
Charged
308.00
Total submitted
Denied
308.00
2 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 | GRACE LOPEZ |
| Role on the policy | Subscriber |
| Policy | B06M000406 |
| Date of birth | 14 Mar 1966 |
| Plan | SILVER HMO |
| Covered from | 14 Apr 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 |
|---|---|---|---|---|---|
| CLM0001849 | 29 May 2026 | 188.00 | CASCADE CARE | CARC 27 · ELIGIBILITY | 188.00 |
| CLM0001848 | 24 Apr 2025 | 120.00 | CASCADE CARE | CARC 27 · ELIGIBILITY | 120.00 |