VICTOR LOPEZ
Dependent on policy B01M000452
Claims
3
Attributed to this person
Charged
1,040.00
Total submitted
Denied
0.00
0 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 | VICTOR LOPEZ |
| Role on the policy | Dependent · relationship 01 |
| Policy | B01M000452 |
| Date of birth | 13 Jul 1956 |
| Plan | GOLD PPO |
| Covered from | 13 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 |
|---|---|---|---|---|---|
| CLM0002021 | 4 Nov 2025 | 763.00 | CASCADE CARE | Not denied | — |
| CLM0002023 | 21 May 2025 | 83.00 | CASCADE CARE | Not denied | — |
| CLM0002022 | 21 Nov 2024 | 194.00 | CASCADE CARE | Not denied | — |