CARLA LOPEZ
Dependent on policy B03M000036
Claims
2
Attributed to this person
Charged
906.00
Total submitted
Denied
370.00
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 | CARLA LOPEZ |
| Role on the policy | Dependent · relationship 01 |
| Policy | B03M000036 |
| Date of birth | 14 Sep 1950 |
| Plan | SILVER HMO |
| Covered from | 20 Apr 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 |
|---|---|---|---|---|---|
| CLM0000153 | 4 May 2026 | 536.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0000154 | 2 Dec 2024 | 370.00 | MERIDIAN HEALTH PLAN | CARC 27 · ELIGIBILITY | 370.00 |