ELENA LOPEZ
Subscriber on policy B09M000817
Claims
3
Attributed to this person
Charged
1,255.00
Total submitted
Denied
68.80
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 | ELENA LOPEZ |
| Role on the policy | Subscriber |
| Policy | B09M000817 |
| Date of birth | 9 May 1963 |
| Plan | GOLD PPO |
| Covered from | 14 Dec 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 |
|---|---|---|---|---|---|
| CLM0003471 | 17 Jun 2026 | 687.00 | CASCADE CARE | Not denied | — |
| CLM0003469 | 27 Jul 2025 | 294.00 | CASCADE CARE | Not denied | — |
| CLM0003470 | 21 Jun 2025 | 274.00 | CASCADE CARE | CARC 18 · DUPLICATE | 68.80 |