MARCUS LOPEZ
Subscriber on policy B09M000104
Claims
3
Attributed to this person
Charged
2,352.00
Total submitted
Denied
1,011.89
2 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 | MARCUS LOPEZ |
| Role on the policy | Subscriber |
| Policy | B09M000104 |
| Date of birth | 3 Sep 1989 |
| Plan | GOLD PPO |
| Covered from | 20 May 2025 |
| Covered to | 15 Oct 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 |
|---|---|---|---|---|---|
| CLM0000442 | 14 Aug 2025 | 828.00 | MERIDIAN HEALTH PLAN | CARC 27 · ELIGIBILITY | 828.00 |
| CLM0000441 | 29 Jun 2025 | 859.00 | MERIDIAN HEALTH PLAN | CARC 109 · COB | 183.89 |
| CLM0000440 | 1 Jun 2025 | 665.00 | MERIDIAN HEALTH PLAN | Not denied | — |