LEILA LOPEZ
Dependent on policy B03M000637
Claims
2
Attributed to this person
Charged
974.00
Total submitted
Denied
215.00
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 | LEILA LOPEZ |
| Role on the policy | Dependent · relationship 01 |
| Policy | B03M000637 |
| Date of birth | 1 Oct 1946 |
| Plan | PLATINUM PPO |
| Covered from | 19 Oct 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 |
|---|---|---|---|---|---|
| CLM0002629 | 30 Jul 2026 | 215.00 | MERIDIAN HEALTH PLAN | CARC 27 · ELIGIBILITY | 215.00 |
| CLM0002630 | 5 Nov 2024 | 759.00 | MERIDIAN HEALTH PLAN | Not denied | — |