TOMAS LOPEZ
Dependent on policy B01M000377
Claims
1
Attributed to this person
Charged
532.00
Total submitted
Denied
155.23
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 | TOMAS LOPEZ |
| Role on the policy | Dependent · relationship 19 |
| Policy | B01M000377 |
| Date of birth | 20 Nov 2017 |
| Plan | SILVER HMO |
| Covered from | 25 Aug 2024 |
| Covered to | open |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001671 | 26 Jun 2025 | 532.00 | CASCADE CARE | CARC 27 · ELIGIBILITY | 155.23 |