RAVI LOPEZ
Subscriber on policy B07M000145
Claims
1
Attributed to this person
Charged
419.00
Total submitted
Denied
419.00
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 | RAVI LOPEZ |
| Role on the policy | Subscriber |
| Policy | B07M000145 |
| Date of birth | 19 Jan 1977 |
| Plan | GOLD PPO |
| Covered from | 27 Oct 2024 |
| Covered to | 17 Apr 2025 |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000605 | 12 May 2025 | 419.00 | MERIDIAN HEALTH PLAN | CARC 26 · ELIGIBILITY | 419.00 |