MARCUS LOPEZ
Subscriber on policy B03M000363
Claims
2
Attributed to this person
Charged
1,580.00
Total submitted
Denied
861.00
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 | MARCUS LOPEZ |
| Role on the policy | Subscriber |
| Policy | B03M000363 |
| Date of birth | 19 Apr 1968 |
| Plan | SILVER HMO |
| Covered from | 26 Jan 2024 |
| Covered to | 15 Jul 2024 |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001467 | 15 Aug 2024 | 861.00 | MERIDIAN HEALTH PLAN | CARC 29 · TIMELY_FILING | 861.00 |
| CLM0001468 | 15 Jun 2024 | 719.00 | MERIDIAN HEALTH PLAN | Not denied | — |