ELENA JOHNSON
Dependent on policy B09M000479
Claims
2
Attributed to this person
Charged
243.00
Total submitted
Denied
153.80
2 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 | ELENA JOHNSON |
| Role on the policy | Dependent · relationship 19 |
| Policy | B09M000479 |
| Date of birth | 22 Nov 2014 |
| Plan | PLATINUM PPO |
| Covered from | 4 Nov 2024 |
| Covered to | open |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002028 | 7 Jun 2025 | 112.00 | NORTHSTAR MUTUAL | CARC 16 · BILLING_ERROR | 22.80 |
| CLM0002027 | 11 May 2025 | 131.00 | NORTHSTAR MUTUAL | CARC 16 · BILLING_ERROR | 131.00 |