YUSUF LOPEZ
Dependent on policy B04M000511
Claims
3
Attributed to this person
Charged
756.00
Total submitted
Denied
279.00
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 | YUSUF LOPEZ |
| Role on the policy | Dependent · relationship 01 |
| Policy | B04M000511 |
| Date of birth | 23 Apr 1994 |
| Plan | SILVER HMO |
| Covered from | 19 Oct 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 |
|---|---|---|---|---|---|
| CLM0002206 | 18 Jun 2025 | 279.00 | MERIDIAN HEALTH PLAN | CARC 29 · TIMELY_FILING | 279.00 |
| CLM0002208 | 7 May 2025 | 403.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0002207 | 2 Mar 2025 | 74.00 | MERIDIAN HEALTH PLAN | Not denied | — |