KEVIN LOPEZ
Subscriber on policy B10M000274
Claims
2
Attributed to this person
Charged
870.00
Total submitted
Denied
592.06
2 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 | KEVIN LOPEZ |
| Role on the policy | Subscriber |
| Policy | B10M000274 |
| Date of birth | 2 Nov 1990 |
| Plan | PLATINUM PPO |
| Covered from | 24 Jun 2024 |
| Covered to | 3 Sep 2024 |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001142 | 8 Aug 2024 | 350.00 | MERIDIAN HEALTH PLAN | CARC 197 · AUTHORIZATION | 72.06 |
| CLM0001143 | 18 Jun 2024 | 520.00 | MERIDIAN HEALTH PLAN | CARC 26 · ELIGIBILITY | 520.00 |