KEVIN LOPEZ
Subscriber on policy B07M000591
Claims
3
Attributed to this person
Charged
1,174.00
Total submitted
Denied
684.00
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 | KEVIN LOPEZ |
| Role on the policy | Subscriber |
| Policy | B07M000591 |
| Date of birth | 5 Oct 1956 |
| Plan | BRONZE EPO |
| Covered from | 12 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 |
|---|---|---|---|---|---|
| CLM0002491 | 6 Dec 2025 | 490.00 | CASCADE CARE | Not denied | — |
| CLM0002492 | 19 Jun 2025 | 208.00 | CASCADE CARE | CARC 18 · DUPLICATE | 208.00 |
| CLM0002490 | 16 Jan 2025 | 476.00 | CASCADE CARE | CARC 26 · ELIGIBILITY | 476.00 |