HENRY JOHNSON
Subscriber on policy B06M000490
Claims
3
Attributed to this person
Charged
1,713.00
Total submitted
Denied
463.00
1 denied claims
Patient responsibility
121.20
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 | HENRY JOHNSON |
| Role on the policy | Subscriber |
| Policy | B06M000490 |
| Date of birth | 7 Jul 1997 |
| Plan | BRONZE EPO |
| Covered from | 10 Sep 2024 |
| Covered to | 20 Nov 2024 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 121.20 |
| Total | 121.20 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002202 | 4 Jan 2025 | 463.00 | CASCADE CARE | CARC 27 · ELIGIBILITY | 463.00 |
| CLM0002204 | 13 Sep 2024 | 644.00 | CASCADE CARE | Not denied | — |
| CLM0002203 | 14 Aug 2024 | 606.00 | CASCADE CARE | Not denied | — |