JULIA LOPEZ
Subscriber on policy B03M000099
Claims
3
Attributed to this person
Charged
2,171.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
176.40
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 | JULIA LOPEZ |
| Role on the policy | Subscriber |
| Policy | B03M000099 |
| Date of birth | 17 Aug 1983 |
| Plan | GOLD PPO |
| Covered from | 13 Jul 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 176.40 |
| Total | 176.40 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000410 | 23 Oct 2025 | 429.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0000409 | 29 Jun 2025 | 882.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0000408 | 4 Feb 2025 | 860.00 | MERIDIAN HEALTH PLAN | Not denied | — |