NADIA LOPEZ
Dependent on policy B01M000506
Claims
3
Attributed to this person
Charged
848.00
Total submitted
Denied
124.58
1 denied claims
Patient responsibility
22.95
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 | NADIA LOPEZ |
| Role on the policy | Dependent · relationship 01 |
| Policy | B01M000506 |
| Date of birth | 13 May 1977 |
| Plan | PLATINUM PPO |
| Covered from | 4 Feb 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 22.95 |
| Total | 22.95 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002272 | 3 Mar 2026 | 485.00 | MERIDIAN HEALTH PLAN | CARC 11 · CODING | 124.58 |
| CLM0002271 | 29 Nov 2024 | 210.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0002273 | 27 Aug 2024 | 153.00 | MERIDIAN HEALTH PLAN | Not denied | — |