TOMAS JOHNSON
Dependent on policy B09M000542
Claims
1
Attributed to this person
Charged
308.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
61.60
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 | TOMAS JOHNSON |
| Role on the policy | Dependent · relationship 19 |
| Policy | B09M000542 |
| Date of birth | 29 Nov 2015 |
| Plan | BRONZE EPO |
| Covered from | 11 Mar 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 61.60 |
| Total | 61.60 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002280 | 12 Jun 2025 | 308.00 | CASCADE CARE | Not denied | — |