TOMAS LOPEZ
Subscriber on policy B03M000806
Claims
1
Attributed to this person
Charged
390.00
Total submitted
Denied
390.00
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 | TOMAS LOPEZ |
| Role on the policy | Subscriber |
| Policy | B03M000806 |
| Date of birth | 15 Apr 1965 |
| Plan | BRONZE EPO |
| Covered from | 2 Apr 2025 |
| Covered to | 28 Oct 2025 |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003461 | 12 Mar 2025 | 390.00 | MERIDIAN HEALTH PLAN | CARC 26 · ELIGIBILITY | 390.00 |