IVAN LOPEZ
Dependent on policy B03M000036
Claims
3
Attributed to this person
Charged
810.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
37.65
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 | IVAN LOPEZ |
| Role on the policy | Dependent · relationship 19 |
| Policy | B03M000036 |
| Date of birth | 6 Feb 1990 |
| Plan | SILVER HMO |
| Covered from | 20 Apr 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 37.65 |
| Total | 37.65 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000156 | 27 May 2026 | 251.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0000157 | 13 Dec 2024 | 485.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0000155 | 26 Aug 2024 | 74.00 | MERIDIAN HEALTH PLAN | Not denied | — |