GRACE JOHNSON
Dependent on policy B09M000036
Claims
3
Attributed to this person
Charged
1,757.00
Total submitted
Denied
322.00
1 denied claims
Patient responsibility
133.95
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 | GRACE JOHNSON |
| Role on the policy | Dependent · relationship 19 |
| Policy | B09M000036 |
| Date of birth | 22 Sep 2016 |
| Plan | GOLD PPO |
| Covered from | 20 Jan 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 133.95 |
| Total | 133.95 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000176 | 3 Jun 2025 | 542.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0000175 | 23 May 2025 | 322.00 | MERIDIAN HEALTH PLAN | CARC 29 · TIMELY_FILING | 322.00 |
| CLM0000177 | 26 Feb 2025 | 893.00 | MERIDIAN HEALTH PLAN | Not denied | — |