RAVI JOHNSON
Dependent on policy B08M000549
Claims
3
Attributed to this person
Charged
1,825.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
15.00
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 | RAVI JOHNSON |
| Role on the policy | Dependent · relationship 01 |
| Policy | B08M000549 |
| Date of birth | 22 Sep 1947 |
| Plan | BRONZE EPO |
| Covered from | 20 Oct 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 3 · Copay | 1 | 15.00 |
| Total | 15.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002516 | 28 Jul 2026 | 794.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0002518 | 17 Apr 2025 | 495.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0002517 | 28 Sep 2024 | 536.00 | NORTHSTAR MUTUAL | Not denied | — |