AMARA LOPEZ
Dependent on policy B04M000285
Claims
2
Attributed to this person
Charged
1,455.00
Total submitted
Denied
151.81
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 | AMARA LOPEZ |
| Role on the policy | Dependent · relationship 01 |
| Policy | B04M000285 |
| Date of birth | 12 Aug 1991 |
| Plan | SILVER HMO |
| Covered from | 19 Feb 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 |
|---|---|---|---|---|---|
| CLM0001231 | 24 Apr 2026 | 846.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0001230 | 10 Dec 2025 | 609.00 | MERIDIAN HEALTH PLAN | CARC 11 · CODING | 151.81 |