YUSUF LOPEZ
Dependent on policy B01M000452
Claims
2
Attributed to this person
Charged
1,564.00
Total submitted
Denied
684.00
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 | YUSUF LOPEZ |
| Role on the policy | Dependent · relationship 19 |
| Policy | B01M000452 |
| Date of birth | 22 Apr 2001 |
| 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 |
|---|---|---|---|---|---|
| CLM0002029 | 28 Sep 2025 | 684.00 | CASCADE CARE | CARC 50 · MEDICAL_NECESSITY | 684.00 |
| CLM0002028 | 20 May 2025 | 880.00 | CASCADE CARE | Not denied | — |