IVAN LOPEZ
Dependent on policy B08M000617
Claims
3
Attributed to this person
Charged
1,695.00
Total submitted
Denied
812.00
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 | IVAN LOPEZ |
| Role on the policy | Dependent · relationship 19 |
| Policy | B08M000617 |
| Date of birth | 12 Aug 2016 |
| Plan | PLATINUM PPO |
| Covered from | 8 Feb 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 |
|---|---|---|---|---|---|
| CLM0002811 | 27 Nov 2025 | 458.00 | CASCADE CARE | Not denied | — |
| CLM0002810 | 24 Apr 2025 | 812.00 | CASCADE CARE | CARC 197 · AUTHORIZATION | 812.00 |
| CLM0002812 | 27 Nov 2024 | 425.00 | CASCADE CARE | Not denied | — |