AMARA LOPEZ
Dependent on policy B03M000546
Claims
2
Attributed to this person
Charged
1,265.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
99.15
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 | AMARA LOPEZ |
| Role on the policy | Dependent · relationship 01 |
| Policy | B03M000546 |
| Date of birth | 14 Mar 1945 |
| Plan | SILVER HMO |
| Covered from | 26 Jun 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 99.15 |
| Total | 99.15 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002252 | 8 Sep 2024 | 604.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0002251 | 9 Jul 2024 | 661.00 | MERIDIAN HEALTH PLAN | Not denied | — |