DAVID LOPEZ
Dependent on policy B06M000494
Claims
1
Attributed to this person
Charged
697.00
Total submitted
Denied
697.00
1 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 | DAVID LOPEZ |
| Role on the policy | Dependent · relationship 01 |
| Policy | B06M000494 |
| Date of birth | 11 Mar 1983 |
| Plan | SILVER HMO |
| Covered from | 8 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 |
|---|---|---|---|---|---|
| CLM0002216 | 23 Jan 2025 | 697.00 | CASCADE CARE | CARC 27 · ELIGIBILITY | 697.00 |