TOMAS LOPEZ
Dependent on policy B05M000624
Claims
3
Attributed to this person
Charged
1,966.00
Total submitted
Denied
1,300.00
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 | TOMAS LOPEZ |
| Role on the policy | Dependent · relationship 19 |
| Policy | B05M000624 |
| Date of birth | 27 Jan 2012 |
| Plan | SILVER HMO |
| Covered from | 24 Dec 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 |
|---|---|---|---|---|---|
| CLM0002692 | 18 Dec 2025 | 666.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0002691 | 9 Jul 2025 | 753.00 | MERIDIAN HEALTH PLAN | CARC 27 · ELIGIBILITY | 753.00 |
| CLM0002690 | 7 Dec 2024 | 547.00 | MERIDIAN HEALTH PLAN | CARC 26 · ELIGIBILITY | 547.00 |