SOFIA LOPEZ
Dependent on policy B08M000484
Claims
3
Attributed to this person
Charged
1,036.00
Total submitted
Denied
180.00
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 | SOFIA LOPEZ |
| Role on the policy | Dependent · relationship 01 |
| Policy | B08M000484 |
| Date of birth | 15 Jun 1983 |
| Plan | GOLD PPO |
| Covered from | 15 Jul 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 |
|---|---|---|---|---|---|
| CLM0002251 | 19 Jan 2026 | 180.00 | CASCADE CARE | CARC 27 · ELIGIBILITY | 180.00 |
| CLM0002250 | 15 Jan 2026 | 640.00 | CASCADE CARE | Not denied | — |
| CLM0002249 | 16 Apr 2025 | 216.00 | CASCADE CARE | Not denied | — |