JULIA LOPEZ
Subscriber on policy B09M000241
Claims
3
Attributed to this person
Charged
1,483.00
Total submitted
Denied
22.81
1 denied claims
Patient responsibility
96.00
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 | JULIA LOPEZ |
| Role on the policy | Subscriber |
| Policy | B09M000241 |
| Date of birth | 13 Dec 1996 |
| Plan | SILVER HMO |
| Covered from | 26 Oct 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 96.00 |
| Total | 96.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000978 | 1 Jun 2026 | 211.00 | CASCADE CARE | Not denied | — |
| CLM0000980 | 3 Mar 2026 | 480.00 | CASCADE CARE | Not denied | — |
| CLM0000979 | 12 Sep 2025 | 792.00 | CASCADE CARE | CARC 197 · AUTHORIZATION | 22.81 |