CARLA LOPEZ
Dependent on policy B09M000497
Claims
3
Attributed to this person
Charged
1,774.00
Total submitted
Denied
1,083.04
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 | CARLA LOPEZ |
| Role on the policy | Dependent · relationship 19 |
| Policy | B09M000497 |
| Date of birth | 10 Jul 2003 |
| Plan | SILVER HMO |
| Covered from | 28 Oct 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 |
|---|---|---|---|---|---|
| CLM0002096 | 22 Jan 2026 | 658.00 | MERIDIAN HEALTH PLAN | CARC 29 · TIMELY_FILING | 658.00 |
| CLM0002098 | 28 Feb 2025 | 250.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0002097 | 9 Nov 2024 | 866.00 | MERIDIAN HEALTH PLAN | CARC 18 · DUPLICATE | 425.04 |