YUSUF LOPEZ
Subscriber on policy B04M000285
Claims
3
Attributed to this person
Charged
1,046.00
Total submitted
Denied
239.00
1 denied claims
Patient responsibility
51.00
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 | YUSUF LOPEZ |
| Role on the policy | Subscriber |
| Policy | B04M000285 |
| Date of birth | 13 Feb 1992 |
| Plan | SILVER HMO |
| Covered from | 19 Feb 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 51.00 |
| Total | 51.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001229 | 8 Jan 2026 | 552.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0001227 | 19 Jul 2025 | 239.00 | MERIDIAN HEALTH PLAN | CARC 197 · AUTHORIZATION | 239.00 |
| CLM0001228 | 1 Nov 2024 | 255.00 | MERIDIAN HEALTH PLAN | Not denied | — |