UMA LOPEZ
Subscriber on policy B02M000542
Claims
2
Attributed to this person
Charged
1,348.00
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 | UMA LOPEZ |
| Role on the policy | Subscriber |
| Policy | B02M000542 |
| Date of birth | 18 Oct 1955 |
| Plan | GOLD PPO |
| Covered from | 17 Jan 2025 |
| Covered to | 16 Aug 2025 |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002292 | 4 Jun 2025 | 821.00 | CASCADE CARE | Not denied | — |
| CLM0002293 | 19 May 2025 | 527.00 | CASCADE CARE | Not denied | — |