WENDY LOPEZ
Dependent on policy B09M000210
Claims
3
Attributed to this person
Charged
1,576.00
Total submitted
Denied
834.00
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 | WENDY LOPEZ |
| Role on the policy | Dependent · relationship 01 |
| Policy | B09M000210 |
| Date of birth | 25 Aug 1985 |
| 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 |
|---|---|---|---|---|---|
| CLM0000886 | 28 May 2025 | 492.00 | MERIDIAN HEALTH PLAN | CARC 27 · ELIGIBILITY | 492.00 |
| CLM0000885 | 23 May 2025 | 342.00 | MERIDIAN HEALTH PLAN | CARC 27 · ELIGIBILITY | 342.00 |
| CLM0000887 | 7 Dec 2024 | 742.00 | MERIDIAN HEALTH PLAN | Not denied | — |