VICTOR LOPEZ
Subscriber on policy B02M000790
Claims
3
Attributed to this person
Charged
1,657.00
Total submitted
Denied
422.00
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 | VICTOR LOPEZ |
| Role on the policy | Subscriber |
| Policy | B02M000790 |
| Date of birth | 6 Jan 2002 |
| Plan | BRONZE EPO |
| Covered from | 23 Aug 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 |
|---|---|---|---|---|---|
| CLM0003298 | 1 Apr 2026 | 891.00 | CASCADE CARE | Not denied | — |
| CLM0003300 | 23 May 2025 | 344.00 | CASCADE CARE | Not denied | — |
| CLM0003299 | 30 Sep 2024 | 422.00 | CASCADE CARE | CARC 29 · TIMELY_FILING | 422.00 |