PRIYA LOPEZ
Dependent on policy B06M000242
Claims
3
Attributed to this person
Charged
1,101.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
68.20
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 | PRIYA LOPEZ |
| Role on the policy | Dependent · relationship 19 |
| Policy | B06M000242 |
| Date of birth | 12 Oct 1979 |
| Plan | PLATINUM PPO |
| Covered from | 26 May 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 56.20 |
| CARC 1 · Deductible | 1 | 12.00 |
| Total | 68.20 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001150 | 9 Aug 2026 | 80.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0001149 | 18 Feb 2026 | 740.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0001148 | 4 Jan 2026 | 281.00 | MERIDIAN HEALTH PLAN | Not denied | — |