JULIA LOPEZ
Subscriber on policy B09M000727
Claims
2
Attributed to this person
Charged
1,109.00
Total submitted
Denied
441.00
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 | JULIA LOPEZ |
| Role on the policy | Subscriber |
| Policy | B09M000727 |
| Date of birth | 13 Nov 1953 |
| Plan | PLATINUM PPO |
| Covered from | 28 Jan 2025 |
| Covered to | 25 May 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 |
|---|---|---|---|---|---|
| CLM0003074 | 29 May 2025 | 441.00 | CASCADE CARE | CARC 27 · ELIGIBILITY | 441.00 |
| CLM0003075 | 24 Mar 2025 | 668.00 | CASCADE CARE | Not denied | — |