MARCUS LOPEZ
Subscriber on policy B01M000139
Claims
1
Attributed to this person
Charged
445.00
Total submitted
Denied
445.00
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 | MARCUS LOPEZ |
| Role on the policy | Subscriber |
| Policy | B01M000139 |
| Date of birth | 25 Apr 1979 |
| Plan | GOLD PPO |
| Covered from | 4 Apr 2025 |
| 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 |
|---|---|---|---|---|---|
| CLM0000570 | 23 Nov 2025 | 445.00 | CASCADE CARE | CARC 18 · DUPLICATE | 445.00 |