ZARA JOHNSON
Dependent on policy B08M000772
Claims
2
Attributed to this person
Charged
1,587.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
50.00
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 | ZARA JOHNSON |
| Role on the policy | Dependent · relationship 01 |
| Policy | B08M000772 |
| Date of birth | 25 Sep 2000 |
| Plan | SILVER HMO |
| Covered from | 17 Nov 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 3 · Copay | 1 | 50.00 |
| Total | 50.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003456 | 27 Feb 2025 | 754.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0003455 | 21 Dec 2024 | 833.00 | MERIDIAN HEALTH PLAN | Not denied | — |