KEVIN LOPEZ
Dependent on policy B05M000049
Claims
3
Attributed to this person
Charged
1,300.00
Total submitted
Denied
141.80
2 denied claims
Patient responsibility
104.65
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 | KEVIN LOPEZ |
| Role on the policy | Dependent · relationship 19 |
| Policy | B05M000049 |
| Date of birth | 8 Oct 2008 |
| Plan | GOLD PPO |
| Covered from | 12 Oct 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 50 · Other | 1 | 104.65 |
| Total | 104.65 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000237 | 15 Mar 2026 | 824.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0000239 | 6 Mar 2026 | 161.00 | MERIDIAN HEALTH PLAN | CARC 50 · MEDICAL_NECESSITY | 0.00 |
| CLM0000238 | 3 Jun 2025 | 315.00 | MERIDIAN HEALTH PLAN | CARC 109 · COB | 141.80 |