OMAR JOHNSON
Subscriber on policy B09M000376
Claims
1
Attributed to this person
Charged
415.00
Total submitted
Denied
415.00
1 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 | OMAR JOHNSON |
| Role on the policy | Subscriber |
| Policy | B09M000376 |
| Date of birth | 1 Feb 1969 |
| Plan | BRONZE EPO |
| Covered from | 28 Mar 2024 |
| Covered to | 19 Jan 2025 |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001558 | 2 Oct 2024 | 415.00 | CASCADE CARE | CARC 27 · ELIGIBILITY | 415.00 |