RAVI LOPEZ
Dependent on policy B05M000695
Claims
1
Attributed to this person
Charged
137.00
Total submitted
Denied
137.00
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 | RAVI LOPEZ |
| Role on the policy | Dependent · relationship 01 |
| Policy | B05M000695 |
| Date of birth | 10 Sep 2007 |
| 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 |
|---|---|---|---|---|---|
| CLM0002990 | 30 Aug 2024 | 137.00 | CASCADE CARE | CARC 18 · DUPLICATE | 137.00 |