JULIA LOPEZ
Dependent on policy B10M000611
Claims
2
Attributed to this person
Charged
1,309.00
Total submitted
Denied
1,309.00
2 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 | JULIA LOPEZ |
| Role on the policy | Dependent · relationship 01 |
| Policy | B10M000611 |
| Date of birth | 12 Sep 1988 |
| Plan | GOLD PPO |
| Covered from | 16 Jun 2024 |
| Covered to | 9 Apr 2025 |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002547 | 8 Nov 2024 | 536.00 | CASCADE CARE | CARC 27 · ELIGIBILITY | 536.00 |
| CLM0002548 | 6 Jun 2024 | 773.00 | CASCADE CARE | CARC 26 · ELIGIBILITY | 773.00 |