UMA LOPEZ
Subscriber on policy B01M000359
Claims
3
Attributed to this person
Charged
1,371.00
Total submitted
Denied
316.00
1 denied claims
Patient responsibility
76.40
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 | UMA LOPEZ |
| Role on the policy | Subscriber |
| Policy | B01M000359 |
| Date of birth | 28 Mar 1992 |
| Plan | BRONZE EPO |
| Covered from | 29 Nov 2024 |
| Covered to | 27 Apr 2025 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 76.40 |
| Total | 76.40 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001582 | 25 Jun 2025 | 316.00 | MERIDIAN HEALTH PLAN | CARC 27 · ELIGIBILITY | 316.00 |
| CLM0001583 | 20 Feb 2025 | 382.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0001584 | 4 Dec 2024 | 673.00 | MERIDIAN HEALTH PLAN | Not denied | — |