JULIA LOPEZ
Dependent on policy B04M000779
Claims
2
Attributed to this person
Charged
704.00
Total submitted
Denied
704.00
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 | JULIA LOPEZ |
| Role on the policy | Dependent · relationship 01 |
| Policy | B04M000779 |
| Date of birth | 5 May 2004 |
| Plan | SILVER HMO |
| Covered from | 23 May 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 |
|---|---|---|---|---|---|
| CLM0003394 | 10 Nov 2025 | 486.00 | CASCADE CARE | CARC 27 · ELIGIBILITY | 486.00 |
| CLM0003395 | 6 May 2025 | 218.00 | CASCADE CARE | CARC 26 · ELIGIBILITY | 218.00 |