AMARA LOPEZ
Dependent on policy B07M000439
Claims
3
Attributed to this person
Charged
1,371.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
138.00
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 | AMARA LOPEZ |
| Role on the policy | Dependent · relationship 01 |
| Policy | B07M000439 |
| Date of birth | 28 Feb 1999 |
| Plan | BRONZE EPO |
| Covered from | 4 May 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 138.00 |
| Total | 138.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001857 | 4 Dec 2025 | 446.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0001858 | 6 May 2025 | 235.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0001856 | 17 Jun 2024 | 690.00 | MERIDIAN HEALTH PLAN | Not denied | — |