HENRY JOHNSON
Dependent on policy B09M000142
Claims
2
Attributed to this person
Charged
708.00
Total submitted
Denied
297.00
1 denied claims
Patient responsibility
50.00
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 | HENRY JOHNSON |
| Role on the policy | Dependent · relationship 19 |
| Policy | B09M000142 |
| Date of birth | 24 Jun 2021 |
| Plan | BRONZE EPO |
| Covered from | 19 May 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 3 · Copay | 1 | 50.00 |
| Total | 50.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000600 | 30 Mar 2026 | 297.00 | CASCADE CARE | CARC 27 · ELIGIBILITY | 297.00 |
| CLM0000599 | 3 Jul 2025 | 411.00 | CASCADE CARE | Not denied | — |