ELENA LOPEZ
Dependent on policy B03M000806
Claims
2
Attributed to this person
Charged
1,178.00
Total submitted
Denied
380.00
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 | ELENA LOPEZ |
| Role on the policy | Dependent · relationship 19 |
| Policy | B03M000806 |
| Date of birth | 16 Nov 2008 |
| 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 |
|---|---|---|---|---|---|
| CLM0003466 | 3 Dec 2025 | 380.00 | MERIDIAN HEALTH PLAN | CARC 27 · ELIGIBILITY | 380.00 |
| CLM0003467 | 30 Apr 2025 | 798.00 | MERIDIAN HEALTH PLAN | Not denied | — |