AMARA LOPEZ
Subscriber on policy B08M000178
Claims
1
Attributed to this person
Charged
805.00
Total submitted
Denied
805.00
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 | AMARA LOPEZ |
| Role on the policy | Subscriber |
| Policy | B08M000178 |
| Date of birth | 19 Mar 1982 |
| Plan | PLATINUM PPO |
| Covered from | 18 Aug 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 |
|---|---|---|---|---|---|
| CLM0000800 | 19 Nov 2024 | 805.00 | MERIDIAN HEALTH PLAN | CARC 27 · ELIGIBILITY | 805.00 |