CARLA LOPEZ
Dependent on policy B03M000160
Claims
1
Attributed to this person
Charged
352.00
Total submitted
Denied
0.00
0 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 | B03M000160 |
| Date of birth | 12 Jul 1973 |
| 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 |
|---|---|---|---|---|---|
| CLM0000658 | 18 Sep 2024 | 352.00 | MERIDIAN HEALTH PLAN | Not denied | — |