PRIYA LOPEZ
Dependent on policy B05M000192
Claims
3
Attributed to this person
Charged
1,689.00
Total submitted
Denied
1,022.00
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 | PRIYA LOPEZ |
| Role on the policy | Dependent · relationship 01 |
| Policy | B05M000192 |
| Date of birth | 3 Jul 1990 |
| 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 |
|---|---|---|---|---|---|
| CLM0000808 | 27 Jan 2025 | 164.00 | MERIDIAN HEALTH PLAN | CARC 27 · ELIGIBILITY | 164.00 |
| CLM0000807 | 12 Jan 2025 | 858.00 | MERIDIAN HEALTH PLAN | CARC 27 · ELIGIBILITY | 858.00 |
| CLM0000809 | 14 Oct 2024 | 667.00 | MERIDIAN HEALTH PLAN | Not denied | — |