FIONA LOPEZ
Subscriber on policy B08M000747
Claims
3
Attributed to this person
Charged
1,656.00
Total submitted
Denied
84.32
1 denied claims
Patient responsibility
78.75
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 | FIONA LOPEZ |
| Role on the policy | Subscriber |
| Policy | B08M000747 |
| Date of birth | 4 Jan 1998 |
| Plan | PLATINUM PPO |
| Covered from | 27 Mar 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 78.75 |
| Total | 78.75 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003343 | 5 Jul 2026 | 888.00 | CASCADE CARE | Not denied | — |
| CLM0003344 | 17 Apr 2026 | 525.00 | CASCADE CARE | Not denied | — |
| CLM0003345 | 22 Jun 2025 | 243.00 | CASCADE CARE | CARC 26 · ELIGIBILITY | 84.32 |