TOMAS JOHNSON
Subscriber on policy B09M000273
Claims
3
Attributed to this person
Charged
2,390.00
Total submitted
Denied
1,275.24
3 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 | TOMAS JOHNSON |
| Role on the policy | Subscriber |
| Policy | B09M000273 |
| Date of birth | 28 Aug 2001 |
| Plan | GOLD PPO |
| Covered from | 24 May 2025 |
| Covered to | 15 Dec 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 |
|---|---|---|---|---|---|
| CLM0001129 | 23 Oct 2025 | 704.00 | MERIDIAN HEALTH PLAN | CARC 11 · CODING | 704.00 |
| CLM0001130 | 19 Aug 2025 | 809.00 | MERIDIAN HEALTH PLAN | CARC 96 · NON_COVERED | 178.72 |
| CLM0001128 | 31 May 2025 | 877.00 | MERIDIAN HEALTH PLAN | CARC 197 · AUTHORIZATION | 392.52 |