SOFIA JOHNSON
Dependent on policy B01M000114
Claims
3
Attributed to this person
Charged
927.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
20.70
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 | SOFIA JOHNSON |
| Role on the policy | Dependent · relationship 01 |
| Policy | B01M000114 |
| Date of birth | 27 Mar 1950 |
| Plan | BRONZE EPO |
| Covered from | 26 Mar 2024 |
| Covered to | 6 Dec 2024 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 20.70 |
| Total | 20.70 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000452 | 9 Oct 2024 | 726.00 | CASCADE CARE | Not denied | — |
| CLM0000451 | 24 Jun 2024 | 63.00 | CASCADE CARE | Not denied | — |
| CLM0000450 | 12 Mar 2024 | 138.00 | CASCADE CARE | Not denied | — |