UMA LOPEZ
Dependent on policy B09M000361
Claims
2
Attributed to this person
Charged
1,006.00
Total submitted
Denied
156.00
1 denied claims
Patient responsibility
127.50
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 | UMA LOPEZ |
| Role on the policy | Dependent · relationship 01 |
| Policy | B09M000361 |
| Date of birth | 8 Apr 1998 |
| Plan | PLATINUM PPO |
| Covered from | 13 Jun 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 127.50 |
| Total | 127.50 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001491 | 31 Oct 2025 | 850.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0001490 | 16 Jun 2025 | 156.00 | MERIDIAN HEALTH PLAN | CARC 27 · ELIGIBILITY | 156.00 |