CARLA LOPEZ
Dependent on policy B09M000347
Claims
3
Attributed to this person
Charged
1,602.00
Total submitted
Denied
807.00
1 denied claims
Patient responsibility
40.00
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 | CARLA LOPEZ |
| Role on the policy | Dependent · relationship 19 |
| Policy | B09M000347 |
| Date of birth | 23 Nov 2007 |
| Plan | SILVER HMO |
| Covered from | 25 Apr 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 3 · Copay | 1 | 40.00 |
| Total | 40.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001428 | 16 Dec 2025 | 807.00 | MERIDIAN HEALTH PLAN | CARC 27 · ELIGIBILITY | 807.00 |
| CLM0001429 | 27 Sep 2025 | 670.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0001427 | 7 Sep 2025 | 125.00 | MERIDIAN HEALTH PLAN | Not denied | — |