LEILA LOPEZ
Dependent on policy B05M000758
Claims
1
Attributed to this person
Charged
474.00
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 | LEILA LOPEZ |
| Role on the policy | Dependent · relationship 01 |
| Policy | B05M000758 |
| Date of birth | 17 Aug 1967 |
| Plan | BRONZE EPO |
| Covered from | 12 Jul 2024 |
| Covered to | 23 Nov 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 |
|---|---|---|---|---|---|
| CLM0003245 | 18 Aug 2024 | 474.00 | CASCADE CARE | Not denied | — |