GRACE JOHNSON
Dependent on policy B01M000870
Claims
1
Attributed to this person
Charged
66.00
Total submitted
Denied
66.00
1 denied claims
Patient responsibility
0.00
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 | B01M000870 |
| Date of birth | 22 May 1971 |
| Plan | GOLD PPO |
| Covered from | 17 Mar 2024 |
| Covered to | open |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003858 | 29 Nov 2025 | 66.00 | NORTHSTAR MUTUAL | CARC 96 · NON_COVERED | 66.00 |