ZARA JOHNSON
Dependent on policy B09M000272
Claims
3
Attributed to this person
Charged
1,018.00
Total submitted
Denied
0.00
1 denied claims
Patient responsibility
369.85
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 | ZARA JOHNSON |
| Role on the policy | Dependent · relationship 01 |
| Policy | B09M000272 |
| Date of birth | 27 Jun 1967 |
| Plan | GOLD PPO |
| Covered from | 6 Apr 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 50 · Other | 1 | 369.85 |
| Total | 369.85 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001127 | 18 Jun 2026 | 569.00 | NORTHSTAR MUTUAL | CARC 50 · MEDICAL_NECESSITY | 0.00 |
| CLM0001125 | 8 Mar 2026 | 292.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0001126 | 23 Oct 2025 | 157.00 | NORTHSTAR MUTUAL | Not denied | — |