YUSUF LOPEZ
Subscriber on policy B05M000098
Claims
3
Attributed to this person
Charged
690.00
Total submitted
Denied
581.00
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 | YUSUF LOPEZ |
| Role on the policy | Subscriber |
| Policy | B05M000098 |
| Date of birth | 10 May 2002 |
| Plan | GOLD PPO |
| Covered from | 13 Aug 2024 |
| Covered to | 2 Nov 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 |
|---|---|---|---|---|---|
| CLM0000433 | 15 Dec 2024 | 283.00 | CASCADE CARE | CARC 27 · ELIGIBILITY | 283.00 |
| CLM0000431 | 12 Nov 2024 | 109.00 | CASCADE CARE | Not denied | — |
| CLM0000432 | 4 Nov 2024 | 298.00 | CASCADE CARE | CARC 27 · ELIGIBILITY | 298.00 |