AMARA LOPEZ
Dependent on policy B10M000803
Claims
3
Attributed to this person
Charged
1,668.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
105.75
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 | AMARA LOPEZ |
| Role on the policy | Dependent · relationship 01 |
| Policy | B10M000803 |
| Date of birth | 19 Jun 1978 |
| Plan | BRONZE EPO |
| Covered from | 23 May 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 105.75 |
| Total | 105.75 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003387 | 11 May 2025 | 112.00 | CASCADE CARE | Not denied | — |
| CLM0003389 | 23 Jan 2025 | 851.00 | CASCADE CARE | Not denied | — |
| CLM0003388 | 26 Apr 2024 | 705.00 | CASCADE CARE | Not denied | — |