VICTOR LOPEZ
Subscriber on policy B03M000546
Claims
3
Attributed to this person
Charged
510.00
Total submitted
Denied
57.03
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 | VICTOR LOPEZ |
| Role on the policy | Subscriber |
| Policy | B03M000546 |
| Date of birth | 7 Jan 1950 |
| Plan | SILVER HMO |
| Covered from | 26 Jun 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 |
|---|---|---|---|---|---|
| CLM0002248 | 14 Nov 2025 | 174.00 | MERIDIAN HEALTH PLAN | CARC 197 · AUTHORIZATION | 57.03 |
| CLM0002250 | 6 Sep 2025 | 98.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0002249 | 30 Jul 2024 | 238.00 | MERIDIAN HEALTH PLAN | Not denied | — |