MARCUS LOPEZ
Dependent on policy B07M000339
Claims
3
Attributed to this person
Charged
961.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
37.20
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 | MARCUS LOPEZ |
| Role on the policy | Dependent · relationship 01 |
| Policy | B07M000339 |
| Date of birth | 29 Aug 1992 |
| Plan | GOLD PPO |
| Covered from | 13 Jun 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 37.20 |
| Total | 37.20 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001451 | 18 May 2026 | 188.00 | CASCADE CARE | Not denied | — |
| CLM0001449 | 30 May 2025 | 248.00 | CASCADE CARE | Not denied | — |
| CLM0001450 | 6 Apr 2025 | 525.00 | CASCADE CARE | Not denied | — |