HENRY JOHNSON
Subscriber on policy B01M000232
Claims
2
Attributed to this person
Charged
865.00
Total submitted
Denied
865.00
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 | HENRY JOHNSON |
| Role on the policy | Subscriber |
| Policy | B01M000232 |
| Date of birth | 31 Jul 1977 |
| Plan | GOLD PPO |
| Covered from | 13 Oct 2024 |
| Covered to | 13 Dec 2024 |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000980 | 14 Nov 2024 | 776.00 | CASCADE CARE | CARC 11 · CODING | 776.00 |
| CLM0000979 | 12 Nov 2024 | 89.00 | CASCADE CARE | CARC 27 · ELIGIBILITY | 89.00 |