DAVID LOPEZ
Subscriber on policy B03M000384
Claims
3
Attributed to this person
Charged
1,561.00
Total submitted
Denied
670.00
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 | DAVID LOPEZ |
| Role on the policy | Subscriber |
| Policy | B03M000384 |
| Date of birth | 1 Sep 1981 |
| Plan | BRONZE EPO |
| Covered from | 31 Jul 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 |
|---|---|---|---|---|---|
| CLM0001558 | 13 Sep 2025 | 592.00 | CASCADE CARE | CARC 11 · CODING | 592.00 |
| CLM0001557 | 23 Jun 2025 | 78.00 | CASCADE CARE | CARC 27 · ELIGIBILITY | 78.00 |
| CLM0001556 | 29 Sep 2024 | 891.00 | CASCADE CARE | Not denied | — |