DAVID LOPEZ
Subscriber on policy B02M000443
Claims
3
Attributed to this person
Charged
1,959.00
Total submitted
Denied
1,341.00
2 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 | Subscriber |
| Policy | B02M000443 |
| Date of birth | 22 Jul 1977 |
| Plan | SILVER HMO |
| Covered from | 4 Apr 2025 |
| Covered to | 11 Sep 2025 |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001887 | 26 Sep 2025 | 619.00 | MERIDIAN HEALTH PLAN | CARC 27 · ELIGIBILITY | 619.00 |
| CLM0001885 | 14 Jul 2025 | 618.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0001886 | 28 Jun 2025 | 722.00 | MERIDIAN HEALTH PLAN | CARC 29 · TIMELY_FILING | 722.00 |