VICTOR LOPEZ
Dependent on policy B08M000866
Claims
2
Attributed to this person
Charged
545.00
Total submitted
Denied
357.00
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 | VICTOR LOPEZ |
| Role on the policy | Dependent · relationship 19 |
| Policy | B08M000866 |
| Date of birth | 8 Mar 1983 |
| Plan | PLATINUM PPO |
| Covered from | 16 Apr 2025 |
| Covered to | 22 Jun 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 |
|---|---|---|---|---|---|
| CLM0003880 | 20 Apr 2025 | 188.00 | CASCADE CARE | Not denied | — |
| CLM0003881 | 5 Apr 2025 | 357.00 | CASCADE CARE | CARC 26 · ELIGIBILITY | 357.00 |