BRIAN LOPEZ
Dependent on policy B07M000419
Claims
2
Attributed to this person
Charged
1,356.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
125.80
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 | BRIAN LOPEZ |
| Role on the policy | Dependent · relationship 01 |
| Policy | B07M000419 |
| Date of birth | 28 Jul 1975 |
| Plan | SILVER HMO |
| Covered from | 30 Mar 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 125.80 |
| Total | 125.80 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001768 | 9 Aug 2025 | 629.00 | CASCADE CARE | Not denied | — |
| CLM0001767 | 18 Apr 2025 | 727.00 | CASCADE CARE | Not denied | — |