RAVI LOPEZ
Subscriber on policy B04M000856
Claims
3
Attributed to this person
Charged
1,082.00
Total submitted
Denied
900.00
2 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 | B04M000856 |
| Date of birth | 10 May 1981 |
| Plan | SILVER HMO |
| Covered from | 3 Nov 2024 |
| Covered to | 26 Jul 2025 |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003701 | 31 Aug 2025 | 647.00 | MERIDIAN HEALTH PLAN | CARC 27 · ELIGIBILITY | 647.00 |
| CLM0003702 | 29 Aug 2025 | 253.00 | MERIDIAN HEALTH PLAN | CARC 27 · ELIGIBILITY | 253.00 |
| CLM0003700 | 20 Mar 2025 | 182.00 | MERIDIAN HEALTH PLAN | Not denied | — |