YUSUF LOPEZ
Dependent on policy B04M000546
Claims
3
Attributed to this person
Charged
2,009.00
Total submitted
Denied
684.00
1 denied claims
Patient responsibility
30.00
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 19 |
| Policy | B04M000546 |
| Date of birth | 15 Aug 2021 |
| Plan | SILVER HMO |
| Covered from | 26 Dec 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 3 · Copay | 1 | 30.00 |
| Total | 30.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002402 | 25 Aug 2026 | 751.00 | CASCADE CARE | Not denied | — |
| CLM0002404 | 12 Jun 2026 | 574.00 | CASCADE CARE | Not denied | — |
| CLM0002403 | 12 Dec 2024 | 684.00 | CASCADE CARE | CARC 27 · ELIGIBILITY | 684.00 |