RAVI JOHNSON
Subscriber on policy B09M000105
Claims
3
Attributed to this person
Charged
759.00
Total submitted
Denied
520.00
2 denied claims
Patient responsibility
35.85
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 | Subscriber |
| Policy | B09M000105 |
| Date of birth | 12 Sep 1990 |
| Plan | GOLD PPO |
| Covered from | 11 Mar 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 35.85 |
| Total | 35.85 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000443 | 20 Dec 2025 | 239.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0000444 | 13 Jul 2025 | 435.00 | MERIDIAN HEALTH PLAN | CARC 18 · DUPLICATE | 435.00 |
| CLM0000445 | 5 Jun 2025 | 85.00 | MERIDIAN HEALTH PLAN | CARC 109 · COB | 85.00 |