ELENA LOPEZ
Subscriber on policy B04M000031
Claims
2
Attributed to this person
Charged
379.00
Total submitted
Denied
78.00
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 | ELENA LOPEZ |
| Role on the policy | Subscriber |
| Policy | B04M000031 |
| Date of birth | 24 Nov 2003 |
| Plan | GOLD PPO |
| Covered from | 23 Apr 2024 |
| Covered to | 23 Dec 2024 |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000133 | 21 Sep 2024 | 78.00 | MERIDIAN HEALTH PLAN | CARC 29 · TIMELY_FILING | 78.00 |
| CLM0000134 | 16 Jun 2024 | 301.00 | MERIDIAN HEALTH PLAN | Not denied | — |