YUSUF LOPEZ
Dependent on policy B02M000833
Claims
1
Attributed to this person
Charged
208.00
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 | YUSUF LOPEZ |
| Role on the policy | Dependent · relationship 01 |
| Policy | B02M000833 |
| Date of birth | 1 Aug 1954 |
| Plan | GOLD PPO |
| Covered from | 28 Jul 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 |
|---|---|---|---|---|---|
| CLM0003460 | 15 Oct 2024 | 208.00 | MERIDIAN HEALTH PLAN | Not denied | — |