BRIAN LOPEZ
Dependent on policy B08M000268
Claims
3
Attributed to this person
Charged
1,150.00
Total submitted
Denied
67.08
2 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 | Dependent · relationship 19 |
| Policy | B08M000268 |
| Date of birth | 27 Jan 2010 |
| Plan | PLATINUM PPO |
| Covered from | 3 Jan 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 |
|---|---|---|---|---|---|
| CLM0001222 | 4 Dec 2025 | 242.00 | CASCADE CARE | CARC 197 · AUTHORIZATION | 59.97 |
| CLM0001223 | 18 Nov 2025 | 491.00 | CASCADE CARE | Not denied | — |
| CLM0001221 | 5 Aug 2025 | 417.00 | CASCADE CARE | CARC 11 · CODING | 7.11 |