ELENA LOPEZ
Dependent on policy B06M000759
Claims
3
Attributed to this person
Charged
1,239.00
Total submitted
Denied
1,239.00
3 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 | ELENA LOPEZ |
| Role on the policy | Dependent · relationship 19 |
| Policy | B06M000759 |
| Date of birth | 3 Apr 2000 |
| 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 |
|---|---|---|---|---|---|
| CLM0003358 | 30 Aug 2024 | 627.00 | CASCADE CARE | CARC 27 · ELIGIBILITY | 627.00 |
| CLM0003357 | 4 Aug 2024 | 294.00 | CASCADE CARE | CARC 197 · AUTHORIZATION | 294.00 |
| CLM0003359 | 10 Mar 2024 | 318.00 | CASCADE CARE | CARC 26 · ELIGIBILITY | 318.00 |