CARLA JOHNSON
Dependent on policy B09M000628
Claims
3
Attributed to this person
Charged
1,159.00
Total submitted
Denied
939.00
3 denied claims
Patient responsibility
143.00
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 | CARLA JOHNSON |
| Role on the policy | Dependent · relationship 19 |
| Policy | B09M000628 |
| Date of birth | 23 Sep 2008 |
| 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 | 143.00 |
| Total | 143.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002659 | 26 Jun 2025 | 220.00 | MERIDIAN HEALTH PLAN | CARC 50 · MEDICAL_NECESSITY | 0.00 |
| CLM0002658 | 15 Apr 2025 | 637.00 | MERIDIAN HEALTH PLAN | CARC 29 · TIMELY_FILING | 637.00 |
| CLM0002657 | 15 Feb 2025 | 302.00 | MERIDIAN HEALTH PLAN | CARC 197 · AUTHORIZATION | 302.00 |