YUSUF LOPEZ
Subscriber on policy B08M000087
Claims
3
Attributed to this person
Charged
1,734.00
Total submitted
Denied
585.00
1 denied claims
Patient responsibility
111.60
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 | YUSUF LOPEZ |
| Role on the policy | Subscriber |
| Policy | B08M000087 |
| Date of birth | 9 Jun 1965 |
| Plan | PLATINUM PPO |
| Covered from | 13 Dec 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 111.60 |
| Total | 111.60 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000387 | 28 Jan 2026 | 585.00 | MERIDIAN HEALTH PLAN | CARC 29 · TIMELY_FILING | 585.00 |
| CLM0000386 | 14 Jun 2025 | 744.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0000388 | 20 Dec 2024 | 405.00 | MERIDIAN HEALTH PLAN | Not denied | — |