DAVID LOPEZ
Subscriber on policy B09M000482
Claims
1
Attributed to this person
Charged
580.00
Total submitted
Denied
580.00
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 | DAVID LOPEZ |
| Role on the policy | Subscriber |
| Policy | B09M000482 |
| Date of birth | 11 May 1962 |
| Plan | PLATINUM PPO |
| Covered from | 29 Jun 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 |
|---|---|---|---|---|---|
| CLM0002034 | 1 Jul 2025 | 580.00 | MERIDIAN HEALTH PLAN | CARC 27 · ELIGIBILITY | 580.00 |