ELENA JOHNSON
Dependent on policy B08M000404
Claims
3
Attributed to this person
Charged
1,696.00
Total submitted
Denied
981.00
2 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 | ELENA JOHNSON |
| Role on the policy | Dependent · relationship 01 |
| Policy | B08M000404 |
| Date of birth | 4 Oct 1969 |
| Plan | PLATINUM PPO |
| Covered from | 13 Oct 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 |
|---|---|---|---|---|---|
| CLM0001849 | 18 Jun 2026 | 593.00 | NORTHSTAR MUTUAL | CARC 96 · NON_COVERED | 593.00 |
| CLM0001850 | 31 Dec 2025 | 715.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0001848 | 18 Dec 2024 | 388.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 388.00 |