NADIA LOPEZ
Dependent on policy B03M000384
Claims
1
Attributed to this person
Charged
104.00
Total submitted
Denied
104.00
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 | NADIA LOPEZ |
| Role on the policy | Dependent · relationship 01 |
| Policy | B03M000384 |
| Date of birth | 10 Jul 1990 |
| 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 |
|---|---|---|---|---|---|
| CLM0001559 | 2 May 2025 | 104.00 | CASCADE CARE | CARC 27 · ELIGIBILITY | 104.00 |