YUSUF LOPEZ
Subscriber on policy B04M000126
Claims
3
Attributed to this person
Charged
1,505.00
Total submitted
Denied
639.00
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 | B04M000126 |
| Date of birth | 11 Oct 1981 |
| Plan | SILVER HMO |
| Covered from | 4 Sep 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 |
|---|---|---|---|---|---|
| CLM0000581 | 3 Aug 2026 | 676.00 | CASCADE CARE | Not denied | — |
| CLM0000580 | 12 Nov 2025 | 639.00 | CASCADE CARE | CARC 27 · ELIGIBILITY | 639.00 |
| CLM0000579 | 11 Dec 2024 | 190.00 | CASCADE CARE | Not denied | — |