ZARA LOPEZ
Subscriber on policy B03M000047
Claims
2
Attributed to this person
Charged
538.00
Total submitted
Denied
538.00
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 | ZARA LOPEZ |
| Role on the policy | Subscriber |
| Policy | B03M000047 |
| Date of birth | 14 Oct 1976 |
| Plan | BRONZE EPO |
| Covered from | 16 May 2025 |
| Covered to | 9 Jan 2026 |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000208 | 27 Feb 2026 | 297.00 | CASCADE CARE | CARC 27 · ELIGIBILITY | 297.00 |
| CLM0000209 | 15 May 2025 | 241.00 | CASCADE CARE | CARC 26 · ELIGIBILITY | 241.00 |