HENRY LOPEZ
Dependent on policy B07M000480
Claims
3
Attributed to this person
Charged
1,609.00
Total submitted
Denied
582.41
2 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 | HENRY LOPEZ |
| Role on the policy | Dependent · relationship 01 |
| Policy | B07M000480 |
| Date of birth | 12 Oct 1948 |
| Plan | PLATINUM PPO |
| Covered from | 23 Nov 2024 |
| Covered to | open |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002046 | 24 Aug 2026 | 679.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0002047 | 15 May 2026 | 487.00 | MERIDIAN HEALTH PLAN | CARC 16 · BILLING_ERROR | 139.41 |
| CLM0002048 | 6 Apr 2026 | 443.00 | MERIDIAN HEALTH PLAN | CARC 18 · DUPLICATE | 443.00 |