VICTOR LOPEZ
Subscriber on policy B10M000292
Claims
1
Attributed to this person
Charged
197.00
Total submitted
Denied
0.00
0 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 | Subscriber |
| Policy | B10M000292 |
| Date of birth | 1 Apr 1965 |
| Plan | GOLD PPO |
| Covered from | 13 Dec 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 |
|---|---|---|---|---|---|
| CLM0001222 | 16 Jan 2026 | 197.00 | CASCADE CARE | Not denied | — |