IVAN JOHNSON
Dependent on policy B06M000647
Claims
3
Attributed to this person
Charged
792.00
Total submitted
Denied
219.00
1 denied claims
Patient responsibility
60.20
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 JOHNSON |
| Role on the policy | Dependent · relationship 01 |
| Policy | B06M000647 |
| Date of birth | 28 Jan 1993 |
| Plan | GOLD PPO |
| Covered from | 22 Apr 2024 |
| Covered to | 4 Oct 2024 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 60.20 |
| Total | 60.20 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002869 | 30 Sep 2024 | 301.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0002870 | 27 Sep 2024 | 219.00 | MERIDIAN HEALTH PLAN | CARC 11 · CODING | 219.00 |
| CLM0002871 | 30 Jun 2024 | 272.00 | MERIDIAN HEALTH PLAN | Not denied | — |