MARCUS LOPEZ
Subscriber on policy B01M000406
Claims
3
Attributed to this person
Charged
1,120.00
Total submitted
Denied
443.00
1 denied claims
Patient responsibility
30.00
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 | MARCUS LOPEZ |
| Role on the policy | Subscriber |
| Policy | B01M000406 |
| Date of birth | 24 Nov 1979 |
| Plan | GOLD PPO |
| Covered from | 31 Oct 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 3 · Copay | 1 | 30.00 |
| Total | 30.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001802 | 22 Aug 2026 | 396.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0001804 | 25 Jan 2026 | 443.00 | MERIDIAN HEALTH PLAN | CARC 29 · TIMELY_FILING | 443.00 |
| CLM0001803 | 11 Jan 2025 | 281.00 | MERIDIAN HEALTH PLAN | Not denied | — |