VICTOR LOPEZ
Dependent on policy B03M000047
Claims
1
Attributed to this person
Charged
472.00
Total submitted
Denied
0.00
0 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 | VICTOR LOPEZ |
| Role on the policy | Dependent · relationship 01 |
| Policy | B03M000047 |
| Date of birth | 11 May 1972 |
| 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 |
|---|---|---|---|---|---|
| CLM0000210 | 6 Dec 2025 | 472.00 | CASCADE CARE | Not denied | — |