BRIAN LOPEZ
Subscriber on policy B05M000390
Claims
2
Attributed to this person
Charged
612.00
Total submitted
Denied
497.00
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 | BRIAN LOPEZ |
| Role on the policy | Subscriber |
| Policy | B05M000390 |
| Date of birth | 4 Dec 1981 |
| Plan | SILVER HMO |
| Covered from | 30 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 |
|---|---|---|---|---|---|
| CLM0001666 | 28 Dec 2025 | 497.00 | CASCADE CARE | CARC 96 · NON_COVERED | 497.00 |
| CLM0001667 | 21 Jul 2024 | 115.00 | CASCADE CARE | Not denied | — |