VICTOR LOPEZ
Dependent on policy B10M000335
Claims
1
Attributed to this person
Charged
97.00
Total submitted
Denied
97.00
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 | VICTOR LOPEZ |
| Role on the policy | Dependent · relationship 01 |
| Policy | B10M000335 |
| Date of birth | 9 Oct 1952 |
| Plan | PLATINUM PPO |
| Covered from | 19 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 |
|---|---|---|---|---|---|
| CLM0001395 | 15 May 2025 | 97.00 | MERIDIAN HEALTH PLAN | CARC 26 · ELIGIBILITY | 97.00 |