ELENA LOPEZ
Subscriber on policy B05M000695
Claims
3
Attributed to this person
Charged
1,215.00
Total submitted
Denied
0.00
0 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 | ELENA LOPEZ |
| Role on the policy | Subscriber |
| Policy | B05M000695 |
| Date of birth | 22 Jul 2003 |
| Plan | GOLD PPO |
| Covered from | 27 Jan 2024 |
| Covered to | 25 Aug 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 |
|---|---|---|---|---|---|
| CLM0002987 | 24 Apr 2024 | 117.00 | CASCADE CARE | Not denied | — |
| CLM0002988 | 12 Apr 2024 | 202.00 | CASCADE CARE | Not denied | — |
| CLM0002989 | 7 Feb 2024 | 896.00 | CASCADE CARE | Not denied | — |