JULIA LOPEZ
Subscriber on policy B06M000552
Claims
2
Attributed to this person
Charged
652.00
Total submitted
Denied
200.00
1 denied claims
Patient responsibility
67.80
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 | JULIA LOPEZ |
| Role on the policy | Subscriber |
| Policy | B06M000552 |
| Date of birth | 15 Mar 1975 |
| Plan | PLATINUM PPO |
| Covered from | 29 Aug 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 67.80 |
| Total | 67.80 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002470 | 23 Aug 2026 | 452.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0002469 | 1 Jul 2026 | 200.00 | MERIDIAN HEALTH PLAN | CARC 50 · MEDICAL_NECESSITY | 200.00 |