TOMAS JOHNSON
Subscriber on policy B09M000628
Claims
2
Attributed to this person
Charged
823.00
Total submitted
Denied
0.00
1 denied claims
Patient responsibility
320.45
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 | B09M000628 |
| Date of birth | 11 Jun 1991 |
| Plan | PLATINUM PPO |
| Covered from | 18 Jan 2025 |
| Covered to | 5 Nov 2025 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 50 · Other | 1 | 320.45 |
| Total | 320.45 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002651 | 10 Jul 2025 | 493.00 | MERIDIAN HEALTH PLAN | CARC 50 · MEDICAL_NECESSITY | 0.00 |
| CLM0002650 | 31 Mar 2025 | 330.00 | MERIDIAN HEALTH PLAN | Not denied | — |