GRACE JOHNSON
Dependent on policy B07M000734
Claims
3
Attributed to this person
Charged
1,193.00
Total submitted
Denied
762.00
1 denied claims
Patient responsibility
51.00
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 19 |
| Policy | B07M000734 |
| Date of birth | 12 Apr 2003 |
| Plan | PLATINUM PPO |
| Covered from | 16 Mar 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 51.00 |
| Total | 51.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003033 | 27 Apr 2026 | 176.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0003034 | 14 Jan 2025 | 762.00 | MERIDIAN HEALTH PLAN | CARC 27 · ELIGIBILITY | 762.00 |
| CLM0003035 | 24 Mar 2024 | 255.00 | MERIDIAN HEALTH PLAN | Not denied | — |