TOMAS LOPEZ
Dependent on policy B10M000868
Claims
3
Attributed to this person
Charged
1,507.00
Total submitted
Denied
52.84
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 | TOMAS LOPEZ |
| Role on the policy | Dependent · relationship 19 |
| Policy | B10M000868 |
| Date of birth | 1 Feb 1991 |
| 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 |
|---|---|---|---|---|---|
| CLM0003681 | 29 Oct 2025 | 879.00 | CASCADE CARE | Not denied | — |
| CLM0003679 | 4 May 2025 | 472.00 | CASCADE CARE | Not denied | — |
| CLM0003680 | 26 Feb 2025 | 156.00 | CASCADE CARE | CARC 29 · TIMELY_FILING | 52.84 |