AMARA LOPEZ
Dependent on policy B03M000305
Claims
3
Attributed to this person
Charged
1,713.00
Total submitted
Denied
150.00
1 denied claims
Patient responsibility
40.00
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 | AMARA LOPEZ |
| Role on the policy | Dependent · relationship 19 |
| Policy | B03M000305 |
| Date of birth | 24 Nov 2012 |
| Plan | SILVER HMO |
| Covered from | 23 Jan 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 3 · Copay | 1 | 40.00 |
| Total | 40.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001215 | 20 Jan 2026 | 150.00 | CASCADE CARE | CARC 50 · MEDICAL_NECESSITY | 150.00 |
| CLM0001216 | 17 Nov 2025 | 726.00 | CASCADE CARE | Not denied | — |
| CLM0001217 | 4 Jan 2025 | 837.00 | CASCADE CARE | Not denied | — |