WENDY LOPEZ
Dependent on policy B03M000258
Claims
3
Attributed to this person
Charged
1,454.00
Total submitted
Denied
777.54
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 | WENDY LOPEZ |
| Role on the policy | Dependent · relationship 01 |
| Policy | B03M000258 |
| Date of birth | 2 Aug 1970 |
| 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 |
|---|---|---|---|---|---|
| CLM0001028 | 29 May 2026 | 449.00 | CASCADE CARE | Not denied | — |
| CLM0001030 | 16 Sep 2025 | 661.00 | CASCADE CARE | CARC 27 · ELIGIBILITY | 661.00 |
| CLM0001029 | 6 Apr 2025 | 344.00 | CASCADE CARE | CARC 27 · ELIGIBILITY | 116.54 |