ELENA LOPEZ
Dependent on policy B06M000242
Claims
2
Attributed to this person
Charged
1,394.00
Total submitted
Denied
744.00
2 denied claims
Patient responsibility
422.50
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 | Dependent · relationship 01 |
| Policy | B06M000242 |
| Date of birth | 16 Apr 1953 |
| Plan | PLATINUM PPO |
| Covered from | 26 May 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 50 · Other | 1 | 422.50 |
| Total | 422.50 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001146 | 29 Oct 2025 | 744.00 | MERIDIAN HEALTH PLAN | CARC 16 · BILLING_ERROR | 744.00 |
| CLM0001147 | 14 Mar 2025 | 650.00 | MERIDIAN HEALTH PLAN | CARC 50 · MEDICAL_NECESSITY | 0.00 |