AMARA LOPEZ
Subscriber on policy B02M000518
Claims
2
Attributed to this person
Charged
1,293.00
Total submitted
Denied
954.87
2 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 | AMARA LOPEZ |
| Role on the policy | Subscriber |
| Policy | B02M000518 |
| Date of birth | 10 Jan 1962 |
| Plan | PLATINUM PPO |
| Covered from | 19 Feb 2025 |
| 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 |
|---|---|---|---|---|---|
| CLM0002190 | 28 Feb 2026 | 668.00 | CASCADE CARE | CARC 27 · ELIGIBILITY | 329.87 |
| CLM0002191 | 31 Jul 2025 | 625.00 | CASCADE CARE | CARC 18 · DUPLICATE | 625.00 |