DAVID LOPEZ
Dependent on policy B05M000758
Claims
3
Attributed to this person
Charged
1,350.00
Total submitted
Denied
351.00
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 | DAVID LOPEZ |
| Role on the policy | Dependent · relationship 19 |
| Policy | B05M000758 |
| Date of birth | 31 Aug 1997 |
| 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 |
|---|---|---|---|---|---|
| CLM0003246 | 7 Dec 2024 | 351.00 | CASCADE CARE | CARC 27 · ELIGIBILITY | 351.00 |
| CLM0003247 | 19 Nov 2024 | 453.00 | CASCADE CARE | Not denied | — |
| CLM0003248 | 21 Jul 2024 | 546.00 | CASCADE CARE | Not denied | — |