KEVIN LOPEZ
Dependent on policy B07M000625
Claims
2
Attributed to this person
Charged
769.00
Total submitted
Denied
109.17
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 | KEVIN LOPEZ |
| Role on the policy | Dependent · relationship 01 |
| Policy | B07M000625 |
| Date of birth | 30 Sep 1976 |
| Plan | BRONZE EPO |
| Covered from | 21 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 |
|---|---|---|---|---|---|
| CLM0002629 | 31 Jan 2026 | 334.00 | CASCADE CARE | CARC 16 · BILLING_ERROR | 109.17 |
| CLM0002628 | 12 Jun 2025 | 435.00 | CASCADE CARE | Not denied | — |