HENRY LOPEZ
Dependent on policy B01M000578
Claims
2
Attributed to this person
Charged
1,487.00
Total submitted
Denied
864.00
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 | HENRY LOPEZ |
| Role on the policy | Dependent · relationship 01 |
| Policy | B01M000578 |
| Date of birth | 29 Jun 1958 |
| Plan | BRONZE EPO |
| Covered from | 8 Jun 2025 |
| 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 |
|---|---|---|---|---|---|
| CLM0002578 | 4 Apr 2026 | 623.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0002577 | 4 Oct 2025 | 864.00 | MERIDIAN HEALTH PLAN | CARC 16 · BILLING_ERROR | 864.00 |