MARCUS LOPEZ
Dependent on policy B10M000611
Claims
2
Attributed to this person
Charged
1,481.00
Total submitted
Denied
832.00
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 | MARCUS LOPEZ |
| Role on the policy | Dependent · relationship 19 |
| Policy | B10M000611 |
| Date of birth | 11 Feb 2006 |
| 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 |
|---|---|---|---|---|---|
| CLM0002553 | 3 Jun 2025 | 832.00 | CASCADE CARE | CARC 27 · ELIGIBILITY | 832.00 |
| CLM0002552 | 5 Mar 2025 | 649.00 | CASCADE CARE | Not denied | — |