OMAR LOPEZ
Subscriber on policy B09M000474
Claims
3
Attributed to this person
Charged
1,450.00
Total submitted
Denied
51.72
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 | OMAR LOPEZ |
| Role on the policy | Subscriber |
| Policy | B09M000474 |
| Date of birth | 1 Dec 1950 |
| Plan | SILVER HMO |
| Covered from | 14 Aug 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 |
|---|---|---|---|---|---|
| CLM0002005 | 16 Mar 2026 | 700.00 | CASCADE CARE | Not denied | — |
| CLM0002004 | 31 May 2025 | 602.00 | CASCADE CARE | Not denied | — |
| CLM0002006 | 9 Dec 2024 | 148.00 | CASCADE CARE | CARC 197 · AUTHORIZATION | 51.72 |