FIONA LOPEZ
Subscriber on policy B10M000027
Claims
1
Attributed to this person
Charged
277.00
Total submitted
Denied
57.83
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 | FIONA LOPEZ |
| Role on the policy | Subscriber |
| Policy | B10M000027 |
| Date of birth | 21 Aug 1983 |
| Plan | SILVER HMO |
| Covered from | 16 Jun 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 |
|---|---|---|---|---|---|
| CLM0000106 | 14 Dec 2025 | 277.00 | CASCADE CARE | CARC 11 · CODING | 57.83 |