NADIA LOPEZ
Dependent on policy B10M000481
Claims
1
Attributed to this person
Charged
804.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
160.80
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 | NADIA LOPEZ |
| Role on the policy | Dependent · relationship 19 |
| Policy | B10M000481 |
| Date of birth | 22 Jul 2010 |
| Plan | GOLD PPO |
| Covered from | 8 Apr 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 160.80 |
| Total | 160.80 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002000 | 25 Dec 2025 | 804.00 | MERIDIAN HEALTH PLAN | Not denied | — |