YUSUF LOPEZ
Subscriber on policy B05M000192
Claims
1
Attributed to this person
Charged
520.00
Total submitted
Denied
223.07
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 | B05M000192 |
| Date of birth | 27 May 1996 |
| Plan | BRONZE EPO |
| Covered from | 28 Aug 2024 |
| Covered to | 17 Dec 2024 |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000806 | 30 Sep 2024 | 520.00 | MERIDIAN HEALTH PLAN | CARC 197 · AUTHORIZATION | 223.07 |