RAVI LOPEZ
Subscriber on policy B03M000258
Claims
3
Attributed to this person
Charged
1,665.00
Total submitted
Denied
1,445.00
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 | RAVI LOPEZ |
| Role on the policy | Subscriber |
| Policy | B03M000258 |
| Date of birth | 11 Feb 1975 |
| Plan | BRONZE EPO |
| Covered from | 24 Feb 2025 |
| 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 |
|---|---|---|---|---|---|
| CLM0001027 | 13 Aug 2026 | 220.00 | CASCADE CARE | Not denied | — |
| CLM0001026 | 19 Oct 2025 | 889.00 | CASCADE CARE | CARC 16 · BILLING_ERROR | 889.00 |
| CLM0001025 | 25 Jun 2025 | 556.00 | CASCADE CARE | CARC 27 · ELIGIBILITY | 556.00 |