HENRY LOPEZ
Dependent on policy B07M000091
Claims
2
Attributed to this person
Charged
415.00
Total submitted
Denied
136.00
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 | HENRY LOPEZ |
| Role on the policy | Dependent · relationship 01 |
| Policy | B07M000091 |
| Date of birth | 8 Nov 1973 |
| Plan | GOLD PPO |
| Covered from | 14 Oct 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 |
|---|---|---|---|---|---|
| CLM0000384 | 17 May 2026 | 279.00 | CASCADE CARE | Not denied | — |
| CLM0000383 | 21 Jun 2025 | 136.00 | CASCADE CARE | CARC 197 · AUTHORIZATION | 136.00 |