OMAR LOPEZ
Subscriber on policy B03M000300
Claims
2
Attributed to this person
Charged
793.00
Total submitted
Denied
289.00
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 | OMAR LOPEZ |
| Role on the policy | Subscriber |
| Policy | B03M000300 |
| Date of birth | 20 May 1977 |
| Plan | PLATINUM PPO |
| Covered from | 19 Dec 2024 |
| 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 |
|---|---|---|---|---|---|
| CLM0001194 | 1 Oct 2025 | 289.00 | CASCADE CARE | CARC 109 · COB | 289.00 |
| CLM0001193 | 28 Jul 2025 | 504.00 | CASCADE CARE | Not denied | — |