GRACE JOHNSON
Dependent on policy B07M000064
Claims
2
Attributed to this person
Charged
560.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
56.00
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 | GRACE JOHNSON |
| Role on the policy | Dependent · relationship 01 |
| Policy | B07M000064 |
| Date of birth | 1 Dec 1988 |
| Plan | BRONZE EPO |
| Covered from | 11 Apr 2025 |
| Covered to | 22 Dec 2025 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 56.00 |
| Total | 56.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000283 | 29 Aug 2025 | 280.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0000282 | 26 Jun 2025 | 280.00 | MERIDIAN HEALTH PLAN | Not denied | — |