RAVI LOPEZ
Subscriber on policy B04M000417
Claims
3
Attributed to this person
Charged
1,893.00
Total submitted
Denied
646.00
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 | RAVI LOPEZ |
| Role on the policy | Subscriber |
| Policy | B04M000417 |
| Date of birth | 10 Dec 1966 |
| Plan | PLATINUM PPO |
| Covered from | 24 Apr 2025 |
| 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 |
|---|---|---|---|---|---|
| CLM0001793 | 21 Jul 2026 | 495.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0001791 | 2 Jul 2026 | 752.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0001792 | 17 Nov 2025 | 646.00 | MERIDIAN HEALTH PLAN | CARC 27 · ELIGIBILITY | 646.00 |