WENDY LOPEZ
Dependent on policy B02M000736
Claims
3
Attributed to this person
Charged
2,199.00
Total submitted
Denied
586.00
1 denied claims
Patient responsibility
154.60
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 | WENDY LOPEZ |
| Role on the policy | Dependent · relationship 19 |
| Policy | B02M000736 |
| Date of birth | 10 Jul 2014 |
| Plan | PLATINUM PPO |
| Covered from | 11 Feb 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 154.60 |
| Total | 154.60 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003081 | 21 Jun 2026 | 773.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0003080 | 9 Mar 2026 | 586.00 | MERIDIAN HEALTH PLAN | CARC 27 · ELIGIBILITY | 586.00 |
| CLM0003079 | 3 Aug 2025 | 840.00 | MERIDIAN HEALTH PLAN | Not denied | — |