LEILA LOPEZ
Subscriber on policy B05M000438
Claims
3
Attributed to this person
Charged
1,852.00
Total submitted
Denied
551.00
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 | LEILA LOPEZ |
| Role on the policy | Subscriber |
| Policy | B05M000438 |
| Date of birth | 20 Dec 1963 |
| Plan | PLATINUM PPO |
| Covered from | 15 Apr 2025 |
| Covered to | 31 Dec 2025 |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001848 | 17 Feb 2026 | 581.00 | CASCADE CARE | Not denied | — |
| CLM0001846 | 22 Dec 2025 | 720.00 | CASCADE CARE | Not denied | — |
| CLM0001847 | 9 Aug 2025 | 551.00 | CASCADE CARE | CARC 18 · DUPLICATE | 551.00 |