NADIA LOPEZ
Dependent on policy B10M000611
Claims
3
Attributed to this person
Charged
1,629.00
Total submitted
Denied
785.00
1 denied claims
Patient responsibility
90.40
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 | B10M000611 |
| Date of birth | 25 Jan 2013 |
| Plan | GOLD PPO |
| Covered from | 16 Jun 2024 |
| Covered to | 9 Apr 2025 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 90.40 |
| Total | 90.40 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002551 | 27 May 2025 | 785.00 | CASCADE CARE | CARC 27 · ELIGIBILITY | 785.00 |
| CLM0002550 | 8 Apr 2025 | 392.00 | CASCADE CARE | Not denied | — |
| CLM0002549 | 10 Sep 2024 | 452.00 | CASCADE CARE | Not denied | — |