WENDY LOPEZ
Dependent on policy B01M000619
Claims
2
Attributed to this person
Charged
846.00
Total submitted
Denied
64.00
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 | WENDY LOPEZ |
| Role on the policy | Dependent · relationship 01 |
| Policy | B01M000619 |
| Date of birth | 10 Sep 1954 |
| Plan | SILVER HMO |
| Covered from | 6 Jan 2025 |
| Covered to | 27 Aug 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 |
|---|---|---|---|---|---|
| CLM0002766 | 13 Jun 2025 | 782.00 | CASCADE CARE | Not denied | — |
| CLM0002767 | 9 Feb 2025 | 64.00 | CASCADE CARE | CARC 27 · ELIGIBILITY | 64.00 |