RAVI LOPEZ
Subscriber on policy B10M000868
Claims
2
Attributed to this person
Charged
655.00
Total submitted
Denied
213.87
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 | RAVI LOPEZ |
| Role on the policy | Subscriber |
| Policy | B10M000868 |
| Date of birth | 3 Dec 1957 |
| Plan | BRONZE EPO |
| Covered from | 5 Jul 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 |
|---|---|---|---|---|---|
| CLM0003677 | 6 Aug 2026 | 162.00 | CASCADE CARE | Not denied | — |
| CLM0003676 | 25 Feb 2026 | 493.00 | CASCADE CARE | CARC 27 · ELIGIBILITY | 213.87 |