SOFIA LOPEZ
Dependent on policy B10M000803
Claims
2
Attributed to this person
Charged
1,084.00
Total submitted
Denied
723.00
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 | SOFIA LOPEZ |
| Role on the policy | Dependent · relationship 19 |
| Policy | B10M000803 |
| Date of birth | 10 Nov 2013 |
| Plan | BRONZE EPO |
| Covered from | 23 May 2024 |
| Covered to | open |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003393 | 13 Aug 2025 | 361.00 | CASCADE CARE | Not denied | — |
| CLM0003392 | 26 Sep 2024 | 723.00 | CASCADE CARE | CARC 27 · ELIGIBILITY | 723.00 |