GRACE LOPEZ
Dependent on policy B07M000023
Claims
3
Attributed to this person
Charged
857.00
Total submitted
Denied
128.00
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 | GRACE LOPEZ |
| Role on the policy | Dependent · relationship 19 |
| Policy | B07M000023 |
| Date of birth | 31 Dec 1999 |
| Plan | PLATINUM PPO |
| Covered from | 4 Jan 2025 |
| 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 |
|---|---|---|---|---|---|
| CLM0000100 | 22 Jul 2026 | 651.00 | CASCADE CARE | Not denied | — |
| CLM0000101 | 11 Mar 2026 | 78.00 | CASCADE CARE | Not denied | — |
| CLM0000102 | 22 Aug 2025 | 128.00 | CASCADE CARE | CARC 18 · DUPLICATE | 128.00 |