Policy B05M000758
4 people enrolled on this policy.
People
4
On this policy
Claims attributed
9
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) |
|---|---|---|---|---|---|---|
| ZARA LOPEZ | Subscriber | 23 Dec 1964 | 3 | 2 | 970.00 | 0.00 |
| LEILA LOPEZ | Dependent · 01 | 17 Aug 1967 | 1 | 0 | 0.00 | 0.00 |
| WENDY LOPEZ | Dependent · 19 | 28 May 1986 | 2 | 1 | 717.00 | 0.00 |
| DAVID LOPEZ | Dependent · 19 | 31 Aug 1997 | 3 | 1 | 351.00 | 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.