IVAN LOPEZ
Subscriber on policy B06M000487
Claims
1
Attributed to this person
Charged
804.00
Total submitted
Denied
352.44
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 | IVAN LOPEZ |
| Role on the policy | Subscriber |
| Policy | B06M000487 |
| Date of birth | 8 Oct 1959 |
| Plan | SILVER HMO |
| Covered from | 28 May 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 |
|---|---|---|---|---|---|
| CLM0002195 | 4 Apr 2025 | 804.00 | MERIDIAN HEALTH PLAN | CARC 27 · ELIGIBILITY | 352.44 |