LEILA LOPEZ
Dependent on policy B10M000541
Claims
3
Attributed to this person
Charged
697.00
Total submitted
Denied
131.00
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 | LEILA LOPEZ |
| Role on the policy | Dependent · relationship 19 |
| Policy | B10M000541 |
| Date of birth | 5 Apr 2018 |
| Plan | SILVER HMO |
| Covered from | 16 Apr 2024 |
| 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 |
|---|---|---|---|---|---|
| CLM0002246 | 25 Aug 2026 | 101.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0002245 | 18 Jan 2026 | 131.00 | MERIDIAN HEALTH PLAN | CARC 29 · TIMELY_FILING | 131.00 |
| CLM0002244 | 26 Jan 2025 | 465.00 | MERIDIAN HEALTH PLAN | Not denied | — |