NADIA LOPEZ
Subscriber on policy B02M000839
Claims
2
Attributed to this person
Charged
750.00
Total submitted
Denied
363.00
1 denied claims
Patient responsibility
77.40
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 | Subscriber |
| Policy | B02M000839 |
| Date of birth | 13 Dec 1997 |
| Plan | GOLD PPO |
| Covered from | 8 May 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 77.40 |
| Total | 77.40 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003490 | 18 Feb 2026 | 363.00 | CASCADE CARE | CARC 27 · ELIGIBILITY | 363.00 |
| CLM0003491 | 29 Apr 2024 | 387.00 | CASCADE CARE | Not denied | — |