WENDY LOPEZ
Subscriber on policy B07M000885
Claims
2
Attributed to this person
Charged
813.00
Total submitted
Denied
259.62
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 | WENDY LOPEZ |
| Role on the policy | Subscriber |
| Policy | B07M000885 |
| Date of birth | 9 Jun 1979 |
| Plan | GOLD PPO |
| Covered from | 15 Feb 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 |
|---|---|---|---|---|---|
| CLM0003670 | 23 Apr 2026 | 624.00 | CASCADE CARE | CARC 96 · NON_COVERED | 259.62 |
| CLM0003671 | 26 Mar 2024 | 189.00 | CASCADE CARE | Not denied | — |