JULIA LOPEZ
Dependent on policy B03M000804
Claims
2
Attributed to this person
Charged
1,099.00
Total submitted
Denied
898.00
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 | JULIA LOPEZ |
| Role on the policy | Dependent · relationship 19 |
| Policy | B03M000804 |
| Date of birth | 30 Jun 2022 |
| Plan | GOLD PPO |
| Covered from | 11 Jan 2024 |
| Covered to | 20 May 2024 |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003454 | 26 Apr 2024 | 201.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0003453 | 6 Jan 2024 | 898.00 | MERIDIAN HEALTH PLAN | CARC 26 · ELIGIBILITY | 898.00 |