UMA LOPEZ
Subscriber on policy B10M000664
Claims
1
Attributed to this person
Charged
700.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
105.00
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 | UMA LOPEZ |
| Role on the policy | Subscriber |
| Policy | B10M000664 |
| Date of birth | 29 Dec 1950 |
| Plan | GOLD PPO |
| Covered from | 1 Feb 2025 |
| Covered to | 10 Oct 2025 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 105.00 |
| Total | 105.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002754 | 15 Sep 2025 | 700.00 | CASCADE CARE | Not denied | — |