IVAN LOPEZ
Dependent on policy B06M000494
Claims
2
Attributed to this person
Charged
840.00
Total submitted
Denied
242.15
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 | IVAN LOPEZ |
| Role on the policy | Dependent · relationship 19 |
| Policy | B06M000494 |
| Date of birth | 6 Jun 2008 |
| 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 |
|---|---|---|---|---|---|
| CLM0002218 | 6 Feb 2026 | 629.00 | CASCADE CARE | CARC 16 · BILLING_ERROR | 242.15 |
| CLM0002217 | 12 Jul 2024 | 211.00 | CASCADE CARE | Not denied | — |