IVAN LOPEZ
Subscriber on policy B03M000283
Claims
2
Attributed to this person
Charged
1,092.00
Total submitted
Denied
232.00
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 | IVAN LOPEZ |
| Role on the policy | Subscriber |
| Policy | B03M000283 |
| Date of birth | 31 May 1959 |
| Plan | GOLD PPO |
| Covered from | 2 May 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 |
|---|---|---|---|---|---|
| CLM0001124 | 7 Oct 2025 | 860.00 | CASCADE CARE | Not denied | — |
| CLM0001123 | 6 Jul 2025 | 232.00 | CASCADE CARE | CARC 27 · ELIGIBILITY | 232.00 |