TOMAS LOPEZ
Dependent on policy B03M000014
Claims
1
Attributed to this person
Charged
590.00
Total submitted
Denied
590.00
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 | TOMAS LOPEZ |
| Role on the policy | Dependent · relationship 19 |
| Policy | B03M000014 |
| Date of birth | 23 Jun 1976 |
| Plan | BRONZE EPO |
| Covered from | 15 Nov 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 |
|---|---|---|---|---|---|
| CLM0000072 | 15 Jan 2026 | 590.00 | MERIDIAN HEALTH PLAN | CARC 27 · ELIGIBILITY | 590.00 |