AMARA LOPEZ
Subscriber on policy B01M000317
Claims
1
Attributed to this person
Charged
269.00
Total submitted
Denied
269.00
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 | AMARA LOPEZ |
| Role on the policy | Subscriber |
| Policy | B01M000317 |
| Date of birth | 28 Nov 1998 |
| Plan | PLATINUM PPO |
| Covered from | 12 Jul 2024 |
| Covered to | 19 Nov 2024 |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001411 | 21 Nov 2024 | 269.00 | CASCADE CARE | CARC 27 · ELIGIBILITY | 269.00 |