SOFIA LOPEZ
Subscriber on policy B06M000759
Claims
1
Attributed to this person
Charged
643.00
Total submitted
Denied
643.00
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 | SOFIA LOPEZ |
| Role on the policy | Subscriber |
| Policy | B06M000759 |
| Date of birth | 16 Jun 1973 |
| Plan | PLATINUM PPO |
| Covered from | 22 Mar 2024 |
| Covered to | 21 Aug 2024 |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003354 | 29 Feb 2024 | 643.00 | CASCADE CARE | CARC 26 · ELIGIBILITY | 643.00 |