ELENA LOPEZ
Dependent on policy B01M000718
Claims
2
Attributed to this person
Charged
773.00
Total submitted
Denied
181.00
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 | B01M000718 |
| Date of birth | 3 Mar 1994 |
| Plan | PLATINUM PPO |
| Covered from | 29 Jul 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 |
|---|---|---|---|---|---|
| CLM0003198 | 9 Feb 2026 | 181.00 | MERIDIAN HEALTH PLAN | CARC 11 · CODING | 181.00 |
| CLM0003199 | 23 Feb 2025 | 592.00 | MERIDIAN HEALTH PLAN | Not denied | — |