SOFIA LOPEZ
Subscriber on policy B09M000005
Claims
1
Attributed to this person
Charged
473.00
Total submitted
Denied
473.00
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 | SOFIA LOPEZ |
| Role on the policy | Subscriber |
| Policy | B09M000005 |
| Date of birth | 31 Jul 1985 |
| Plan | SILVER HMO |
| Covered from | 7 Oct 2024 |
| Covered to | 19 Apr 2025 |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000019 | 5 Oct 2024 | 473.00 | CASCADE CARE | CARC 26 · ELIGIBILITY | 473.00 |