ZARA JOHNSON
Dependent on policy B08M000065
Claims
3
Attributed to this person
Charged
2,255.00
Total submitted
Denied
187.91
1 denied claims
Patient responsibility
120.60
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 | B08M000065 |
| Date of birth | 14 Nov 1987 |
| Plan | BRONZE EPO |
| Covered from | 19 Oct 2024 |
| Covered to | 5 Feb 2025 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 120.60 |
| Total | 120.60 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000294 | 25 Jan 2025 | 727.00 | CASCADE CARE | Not denied | — |
| CLM0000295 | 1 Jan 2025 | 724.00 | CASCADE CARE | CARC 27 · ELIGIBILITY | 187.91 |
| CLM0000293 | 7 Dec 2024 | 804.00 | CASCADE CARE | Not denied | — |