AMARA LOPEZ
Dependent on policy B07M000683
Claims
1
Attributed to this person
Charged
156.00
Total submitted
Denied
60.59
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 | AMARA LOPEZ |
| Role on the policy | Dependent · relationship 19 |
| Policy | B07M000683 |
| Date of birth | 13 Jul 2006 |
| Plan | BRONZE EPO |
| Covered from | 14 Jun 2025 |
| Covered to | 24 Jan 2026 |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002843 | 30 Aug 2025 | 156.00 | MERIDIAN HEALTH PLAN | CARC 26 · ELIGIBILITY | 60.59 |