RAVI LOPEZ
Subscriber on policy B02M000670
Claims
3
Attributed to this person
Charged
887.00
Total submitted
Denied
188.00
1 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 | RAVI LOPEZ |
| Role on the policy | Subscriber |
| Policy | B02M000670 |
| Date of birth | 30 Dec 1990 |
| Plan | PLATINUM PPO |
| Covered from | 28 Dec 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 |
|---|---|---|---|---|---|
| CLM0002833 | 30 Dec 2025 | 65.00 | CASCADE CARE | Not denied | — |
| CLM0002834 | 13 Nov 2025 | 634.00 | CASCADE CARE | Not denied | — |
| CLM0002832 | 10 Aug 2025 | 188.00 | CASCADE CARE | CARC 29 · TIMELY_FILING | 188.00 |