HENRY LOPEZ
Subscriber on policy B09M000210
Claims
2
Attributed to this person
Charged
791.00
Total submitted
Denied
173.79
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 | HENRY LOPEZ |
| Role on the policy | Subscriber |
| Policy | B09M000210 |
| Date of birth | 16 Jun 1983 |
| Plan | SILVER HMO |
| Covered from | 24 Jul 2024 |
| Covered to | 3 May 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 |
|---|---|---|---|---|---|
| CLM0000884 | 22 Feb 2025 | 372.00 | MERIDIAN HEALTH PLAN | CARC 197 · AUTHORIZATION | 173.79 |
| CLM0000883 | 9 Nov 2024 | 419.00 | MERIDIAN HEALTH PLAN | Not denied | — |