CARLA LOPEZ
Dependent on policy B08M000617
Claims
3
Attributed to this person
Charged
537.00
Total submitted
Denied
163.00
2 denied claims
Patient responsibility
63.05
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 | Dependent · relationship 01 |
| Policy | B08M000617 |
| Date of birth | 30 Mar 1982 |
| Plan | PLATINUM PPO |
| Covered from | 8 Feb 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 50 · Other | 1 | 63.05 |
| Total | 63.05 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002808 | 25 Feb 2026 | 163.00 | CASCADE CARE | CARC 11 · CODING | 163.00 |
| CLM0002809 | 18 Jan 2025 | 277.00 | CASCADE CARE | Not denied | — |
| CLM0002807 | 11 Jun 2024 | 97.00 | CASCADE CARE | CARC 50 · MEDICAL_NECESSITY | 0.00 |