UMA LOPEZ
Subscriber on policy B05M000741
Claims
3
Attributed to this person
Charged
1,536.00
Total submitted
Denied
941.08
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 | UMA LOPEZ |
| Role on the policy | Subscriber |
| Policy | B05M000741 |
| Date of birth | 9 Aug 1979 |
| Plan | GOLD PPO |
| Covered from | 22 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 |
|---|---|---|---|---|---|
| CLM0003153 | 1 Oct 2024 | 231.00 | CASCADE CARE | CARC 18 · DUPLICATE | 110.08 |
| CLM0003152 | 5 Sep 2024 | 474.00 | CASCADE CARE | Not denied | — |
| CLM0003151 | 21 Jun 2024 | 831.00 | CASCADE CARE | CARC 26 · ELIGIBILITY | 831.00 |