YUSUF LOPEZ
Subscriber on policy B04M000738
Claims
2
Attributed to this person
Charged
593.00
Total submitted
Denied
330.00
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 | Subscriber |
| Policy | B04M000738 |
| Date of birth | 21 Sep 1958 |
| Plan | GOLD PPO |
| Covered from | 20 Mar 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 |
|---|---|---|---|---|---|
| CLM0003230 | 22 Oct 2025 | 263.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0003229 | 31 Jul 2025 | 330.00 | MERIDIAN HEALTH PLAN | CARC 27 · ELIGIBILITY | 330.00 |