ZARA LOPEZ
Subscriber on policy B03M000160
Claims
2
Attributed to this person
Charged
514.00
Total submitted
Denied
197.87
2 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 | ZARA LOPEZ |
| Role on the policy | Subscriber |
| Policy | B03M000160 |
| Date of birth | 9 Jan 1980 |
| Plan | BRONZE EPO |
| Covered from | 10 Sep 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 |
|---|---|---|---|---|---|
| CLM0000656 | 5 Jun 2026 | 78.00 | MERIDIAN HEALTH PLAN | CARC 197 · AUTHORIZATION | 15.98 |
| CLM0000657 | 9 May 2025 | 436.00 | MERIDIAN HEALTH PLAN | CARC 29 · TIMELY_FILING | 181.89 |