Policy B03M000174
4 people enrolled on this policy.
People
4
On this policy
Claims attributed
8
To a named person
Policy-level
0
Not attributed to a person
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.
People on this policy
| Name | Role | Born | Claims | Denials | Denied | Patient responsibility (835) |
|---|---|---|---|---|---|---|
| DAVID LOPEZ | Subscriber | 24 Feb 1960 | 2 | 2 | 860.00 | 0.00 |
| YUSUF LOPEZ | Dependent · 01 | 25 Jan 1960 | 2 | 0 | 0.00 | 0.00 |
| HENRY LOPEZ | Dependent · 19 | 21 Apr 1982 | 3 | 2 | 840.00 | 0.00 |
| YUSUF LOPEZ | Dependent · 19 | 31 Jul 1989 | 1 | 0 | 0.00 | 0.00 |
Policy-level claims
Every claim on this policy is attributed to a named person.
Claims are attributed to a person from the patient loop of the 837P — name, date of birth and relationship within the policy — because the transaction carries no patient identifier. A claim that matches nobody, or more than one person, stays with the policy and is shown there rather than being assigned to a guess.