TOMAS LOPEZ
Subscriber on policy B09M000820
Claims
2
Attributed to this person
Charged
673.00
Total submitted
Denied
294.00
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 | TOMAS LOPEZ |
| Role on the policy | Subscriber |
| Policy | B09M000820 |
| Date of birth | 24 Nov 1990 |
| Plan | GOLD PPO |
| Covered from | 10 May 2025 |
| 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 |
|---|---|---|---|---|---|
| CLM0003482 | 12 Aug 2026 | 379.00 | CASCADE CARE | Not denied | — |
| CLM0003481 | 8 Aug 2025 | 294.00 | CASCADE CARE | CARC 27 · ELIGIBILITY | 294.00 |