DAVID LOPEZ
Dependent on policy B07M000625
Claims
2
Attributed to this person
Charged
711.00
Total submitted
Denied
0.00
0 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 | DAVID LOPEZ |
| Role on the policy | Dependent · relationship 19 |
| Policy | B07M000625 |
| Date of birth | 23 Dec 2018 |
| 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 |
|---|---|---|---|---|---|
| CLM0002631 | 2 Aug 2026 | 170.00 | CASCADE CARE | Not denied | — |
| CLM0002630 | 26 Jul 2026 | 541.00 | CASCADE CARE | Not denied | — |