RAVI LOPEZ
Dependent on policy B04M000031
Claims
3
Attributed to this person
Charged
1,803.00
Total submitted
Denied
0.00
0 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 | RAVI LOPEZ |
| Role on the policy | Dependent · relationship 01 |
| Policy | B04M000031 |
| Date of birth | 16 May 2013 |
| 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 |
|---|---|---|---|---|---|
| CLM0000137 | 10 Jan 2025 | 524.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0000136 | 7 Nov 2024 | 423.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0000135 | 26 Apr 2024 | 856.00 | MERIDIAN HEALTH PLAN | Not denied | — |