KEVIN LOPEZ
Dependent on policy B05M000273
Claims
1
Attributed to this person
Charged
658.00
Total submitted
Denied
658.00
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 | KEVIN LOPEZ |
| Role on the policy | Dependent · relationship 01 |
| Policy | B05M000273 |
| Date of birth | 7 Nov 1950 |
| Plan | BRONZE EPO |
| Covered from | 7 Jun 2024 |
| 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 |
|---|---|---|---|---|---|
| CLM0001132 | 3 Apr 2025 | 658.00 | MERIDIAN HEALTH PLAN | CARC 11 · CODING | 658.00 |