DAVID LOPEZ
Subscriber on policy B07M000631
Claims
3
Attributed to this person
Charged
644.00
Total submitted
Denied
314.00
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 | DAVID LOPEZ |
| Role on the policy | Subscriber |
| Policy | B07M000631 |
| Date of birth | 13 Feb 1972 |
| Plan | GOLD PPO |
| Covered from | 31 Mar 2025 |
| Covered to | 30 Sep 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 |
|---|---|---|---|---|---|
| CLM0002646 | 23 Nov 2025 | 230.00 | MERIDIAN HEALTH PLAN | CARC 27 · ELIGIBILITY | 230.00 |
| CLM0002645 | 16 May 2025 | 84.00 | MERIDIAN HEALTH PLAN | CARC 96 · NON_COVERED | 84.00 |
| CLM0002647 | 20 Apr 2025 | 330.00 | MERIDIAN HEALTH PLAN | Not denied | — |