ELENA LOPEZ
Subscriber on policy B07M000141
Claims
3
Attributed to this person
Charged
1,999.00
Total submitted
Denied
894.97
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 | ELENA LOPEZ |
| Role on the policy | Subscriber |
| Policy | B07M000141 |
| Date of birth | 2 Dec 1994 |
| Plan | PLATINUM PPO |
| Covered from | 5 Jun 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 |
|---|---|---|---|---|---|
| CLM0000582 | 20 Nov 2025 | 667.00 | CASCADE CARE | Not denied | — |
| CLM0000581 | 3 Apr 2025 | 709.00 | CASCADE CARE | CARC 27 · ELIGIBILITY | 271.97 |
| CLM0000580 | 24 Jul 2024 | 623.00 | CASCADE CARE | CARC 197 · AUTHORIZATION | 623.00 |