OMAR LOPEZ
Subscriber on policy B10M000012
Claims
1
Attributed to this person
Charged
415.00
Total submitted
Denied
0.00
0 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 | B10M000012 |
| Date of birth | 13 Sep 1957 |
| Plan | GOLD PPO |
| Covered from | 27 Nov 2024 |
| Covered to | 11 Sep 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 |
|---|---|---|---|---|---|
| CLM0000041 | 24 Mar 2025 | 415.00 | MERIDIAN HEALTH PLAN | Not denied | — |