WENDY LOPEZ
Subscriber on policy B08M000706
Claims
2
Attributed to this person
Charged
863.00
Total submitted
Denied
136.52
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 | WENDY LOPEZ |
| Role on the policy | Subscriber |
| Policy | B08M000706 |
| Date of birth | 4 Jun 1964 |
| Plan | BRONZE EPO |
| Covered from | 29 May 2024 |
| Covered to | 27 Jan 2025 |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003177 | 10 Dec 2024 | 325.00 | CASCADE CARE | Not denied | — |
| CLM0003176 | 30 Nov 2024 | 538.00 | CASCADE CARE | CARC 11 · CODING | 136.52 |