CARLA LOPEZ
Subscriber on policy B08M000503
Claims
1
Attributed to this person
Charged
270.00
Total submitted
Denied
0.00
0 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 | CARLA LOPEZ |
| Role on the policy | Subscriber |
| Policy | B08M000503 |
| Date of birth | 18 Aug 1994 |
| Plan | SILVER HMO |
| Covered from | 26 Mar 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 |
|---|---|---|---|---|---|
| CLM0002314 | 20 Jun 2025 | 270.00 | CASCADE CARE | Not denied | — |