FIONA LOPEZ
Dependent on policy B03M000283
Claims
1
Attributed to this person
Charged
776.00
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 | FIONA LOPEZ |
| Role on the policy | Dependent · relationship 01 |
| Policy | B03M000283 |
| Date of birth | 31 Oct 1950 |
| 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 |
|---|---|---|---|---|---|
| CLM0001126 | 25 Jan 2026 | 776.00 | CASCADE CARE | Not denied | — |