NADIA LOPEZ
Subscriber on policy B08M000866
Claims
1
Attributed to this person
Charged
566.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
113.20
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 | NADIA LOPEZ |
| Role on the policy | Subscriber |
| Policy | B08M000866 |
| Date of birth | 4 Jul 1957 |
| Plan | PLATINUM PPO |
| Covered from | 16 Apr 2025 |
| Covered to | 22 Jun 2025 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 113.20 |
| Total | 113.20 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003874 | 16 Apr 2025 | 566.00 | CASCADE CARE | Not denied | — |