CARLA LOPEZ
Subscriber on policy B06M000878
Claims
2
Attributed to this person
Charged
1,270.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
60.15
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 | CARLA LOPEZ |
| Role on the policy | Subscriber |
| Policy | B06M000878 |
| Date of birth | 21 Mar 1987 |
| Plan | SILVER HMO |
| Covered from | 17 Sep 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 60.15 |
| Total | 60.15 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003825 | 16 Dec 2025 | 869.00 | CASCADE CARE | Not denied | — |
| CLM0003826 | 22 Jul 2025 | 401.00 | CASCADE CARE | Not denied | — |