WENDY LOPEZ
Subscriber on policy B06M000427
Claims
1
Attributed to this person
Charged
662.00
Total submitted
Denied
662.00
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 | WENDY LOPEZ |
| Role on the policy | Subscriber |
| Policy | B06M000427 |
| Date of birth | 22 Apr 1971 |
| Plan | BRONZE EPO |
| Covered from | 16 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 |
|---|---|---|---|---|---|
| CLM0001962 | 8 Jun 2024 | 662.00 | MERIDIAN HEALTH PLAN | CARC 26 · ELIGIBILITY | 662.00 |