AMARA JOHNSON
Dependent on policy B01M000502
Claims
3
Attributed to this person
Charged
1,586.00
Total submitted
Denied
883.00
2 denied claims
Patient responsibility
250.90
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 | AMARA JOHNSON |
| Role on the policy | Dependent · relationship 19 |
| Policy | B01M000502 |
| Date of birth | 3 Aug 2005 |
| Plan | PLATINUM PPO |
| Covered from | 8 May 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 50 · Other | 1 | 250.90 |
| Total | 250.90 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002252 | 4 Jul 2026 | 317.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0002253 | 2 Dec 2025 | 883.00 | NORTHSTAR MUTUAL | CARC 96 · NON_COVERED | 883.00 |
| CLM0002251 | 18 Apr 2025 | 386.00 | NORTHSTAR MUTUAL | CARC 50 · MEDICAL_NECESSITY | 0.00 |