GRACE LOPEZ
Dependent on policy B07M000145
Claims
2
Attributed to this person
Charged
323.00
Total submitted
Denied
0.00
0 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 | GRACE LOPEZ |
| Role on the policy | Dependent · relationship 01 |
| Policy | B07M000145 |
| Date of birth | 27 Sep 1978 |
| 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 |
|---|---|---|---|---|---|
| CLM0000607 | 16 Apr 2025 | 62.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0000606 | 23 Mar 2025 | 261.00 | MERIDIAN HEALTH PLAN | Not denied | — |