ELENA LOPEZ
Dependent on policy B01M000477
Claims
3
Attributed to this person
Charged
1,371.00
Total submitted
Denied
1,124.00
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 | ELENA LOPEZ |
| Role on the policy | Dependent · relationship 19 |
| Policy | B01M000477 |
| Date of birth | 15 Sep 1990 |
| 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 |
|---|---|---|---|---|---|
| CLM0002127 | 20 Feb 2026 | 687.00 | CASCADE CARE | CARC 18 · DUPLICATE | 687.00 |
| CLM0002128 | 30 May 2025 | 247.00 | CASCADE CARE | Not denied | — |
| CLM0002129 | 15 Jan 2025 | 437.00 | CASCADE CARE | CARC 96 · NON_COVERED | 437.00 |