DAVID LOPEZ
Dependent on policy B10M000876
Claims
1
Attributed to this person
Charged
112.00
Total submitted
Denied
0.00
0 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 | DAVID LOPEZ |
| Role on the policy | Dependent · relationship 01 |
| Policy | B10M000876 |
| Date of birth | 26 Oct 1988 |
| 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 |
|---|---|---|---|---|---|
| CLM0003720 | 25 Jun 2025 | 112.00 | CASCADE CARE | Not denied | — |