KEVIN LOPEZ
Dependent on policy B02M000549
Claims
3
Attributed to this person
Charged
1,158.00
Total submitted
Denied
277.00
2 denied claims
Patient responsibility
284.70
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 | KEVIN LOPEZ |
| Role on the policy | Dependent · relationship 19 |
| Policy | B02M000549 |
| Date of birth | 8 Jul 2023 |
| Plan | SILVER HMO |
| Covered from | 17 May 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 96 · Other | 1 | 284.70 |
| Total | 284.70 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002324 | 3 Oct 2025 | 277.00 | MERIDIAN HEALTH PLAN | CARC 29 · TIMELY_FILING | 277.00 |
| CLM0002325 | 2 Oct 2025 | 443.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0002326 | 7 Jan 2025 | 438.00 | MERIDIAN HEALTH PLAN | CARC 96 · NON_COVERED | 0.00 |