IVAN LOPEZ
Subscriber on policy B01M000670
Claims
3
Attributed to this person
Charged
1,294.00
Total submitted
Denied
633.17
2 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 | IVAN LOPEZ |
| Role on the policy | Subscriber |
| Policy | B01M000670 |
| Date of birth | 24 Sep 1999 |
| Plan | PLATINUM PPO |
| Covered from | 26 Feb 2024 |
| 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 |
|---|---|---|---|---|---|
| CLM0003005 | 16 Feb 2026 | 365.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0003007 | 9 Jul 2025 | 370.00 | MERIDIAN HEALTH PLAN | CARC 109 · COB | 370.00 |
| CLM0003006 | 26 Aug 2024 | 559.00 | MERIDIAN HEALTH PLAN | CARC 197 · AUTHORIZATION | 263.17 |