BRIAN LOPEZ
Subscriber on policy B01M000192
Claims
1
Attributed to this person
Charged
275.00
Total submitted
Denied
275.00
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 | BRIAN LOPEZ |
| Role on the policy | Subscriber |
| Policy | B01M000192 |
| Date of birth | 24 Oct 1962 |
| Plan | GOLD PPO |
| Covered from | 22 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 |
|---|---|---|---|---|---|
| CLM0000823 | 11 Aug 2024 | 275.00 | CASCADE CARE | CARC 26 · ELIGIBILITY | 275.00 |