VICTOR LOPEZ
Subscriber on policy B03M000755
Claims
3
Attributed to this person
Charged
1,441.00
Total submitted
Denied
497.00
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 | VICTOR LOPEZ |
| Role on the policy | Subscriber |
| Policy | B03M000755 |
| Date of birth | 13 Jul 1956 |
| Plan | SILVER HMO |
| Covered from | 29 Jan 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 |
|---|---|---|---|---|---|
| CLM0003165 | 7 Jul 2026 | 328.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0003164 | 18 Dec 2025 | 616.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0003166 | 28 Oct 2025 | 497.00 | MERIDIAN HEALTH PLAN | CARC 29 · TIMELY_FILING | 497.00 |