DAVID JOHNSON
Subscriber on policy B08M000779
Claims
3
Attributed to this person
Charged
1,234.00
Total submitted
Denied
721.00
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 | DAVID JOHNSON |
| Role on the policy | Subscriber |
| Policy | B08M000779 |
| Date of birth | 14 Nov 1996 |
| Plan | BRONZE EPO |
| Covered from | 16 Jun 2025 |
| Covered to | 18 Sep 2025 |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003490 | 25 Sep 2025 | 254.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 254.00 |
| CLM0003491 | 25 Jul 2025 | 467.00 | NORTHSTAR MUTUAL | CARC 18 · DUPLICATE | 467.00 |
| CLM0003489 | 4 Jun 2025 | 513.00 | NORTHSTAR MUTUAL | Not denied | — |