RAVI LOPEZ
Dependent on policy B01M000477
Claims
1
Attributed to this person
Charged
427.00
Total submitted
Denied
427.00
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 | RAVI LOPEZ |
| Role on the policy | Dependent · relationship 01 |
| Policy | B01M000477 |
| Date of birth | 14 Feb 1946 |
| Plan | PLATINUM PPO |
| Covered from | 24 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 |
|---|---|---|---|---|---|
| CLM0002124 | 9 May 2025 | 427.00 | CASCADE CARE | CARC 11 · CODING | 427.00 |