UMA LOPEZ
Subscriber on policy B08M000470
Claims
1
Attributed to this person
Charged
314.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
62.80
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 | UMA LOPEZ |
| Role on the policy | Subscriber |
| Policy | B08M000470 |
| Date of birth | 28 Jun 1977 |
| Plan | BRONZE EPO |
| Covered from | 14 Aug 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 62.80 |
| Total | 62.80 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002175 | 19 Sep 2025 | 314.00 | MERIDIAN HEALTH PLAN | Not denied | — |