AMARA LOPEZ
Dependent on policy B05M000049
Claims
2
Attributed to this person
Charged
497.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
44.60
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 | AMARA LOPEZ |
| Role on the policy | Dependent · relationship 01 |
| Policy | B05M000049 |
| Date of birth | 19 Jan 2009 |
| Plan | GOLD PPO |
| Covered from | 12 Oct 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 44.60 |
| Total | 44.60 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000230 | 19 Jul 2026 | 274.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0000229 | 27 Apr 2026 | 223.00 | MERIDIAN HEALTH PLAN | Not denied | — |