SOFIA LOPEZ
Subscriber on policy B01M000718
Claims
2
Attributed to this person
Charged
660.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
48.15
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 | SOFIA LOPEZ |
| Role on the policy | Subscriber |
| Policy | B01M000718 |
| Date of birth | 6 Oct 1969 |
| Plan | PLATINUM PPO |
| Covered from | 29 Jul 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 48.15 |
| Total | 48.15 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003195 | 21 Mar 2025 | 339.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0003194 | 12 Sep 2024 | 321.00 | MERIDIAN HEALTH PLAN | Not denied | — |