GRACE LOPEZ
Subscriber on policy B10M000876
Claims
1
Attributed to this person
Charged
148.00
Total submitted
Denied
60.20
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 | GRACE LOPEZ |
| Role on the policy | Subscriber |
| Policy | B10M000876 |
| Date of birth | 30 Nov 1984 |
| Plan | BRONZE EPO |
| Covered from | 7 Dec 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 |
|---|---|---|---|---|---|
| CLM0003719 | 11 Jul 2025 | 148.00 | CASCADE CARE | CARC 197 · AUTHORIZATION | 60.20 |