ELENA LOPEZ
Subscriber on policy B08M000484
Claims
2
Attributed to this person
Charged
1,236.00
Total submitted
Denied
0.00
1 denied claims
Patient responsibility
537.55
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 | ELENA LOPEZ |
| Role on the policy | Subscriber |
| Policy | B08M000484 |
| Date of birth | 8 Jun 1991 |
| Plan | GOLD PPO |
| Covered from | 15 Jul 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 96 · Other | 1 | 537.55 |
| Total | 537.55 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002247 | 7 May 2025 | 409.00 | CASCADE CARE | Not denied | — |
| CLM0002248 | 28 Apr 2025 | 827.00 | CASCADE CARE | CARC 96 · NON_COVERED | 0.00 |