CARLA JOHNSON
Subscriber on policy B09M000774
Claims
2
Attributed to this person
Charged
452.00
Total submitted
Denied
452.00
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 | CARLA JOHNSON |
| Role on the policy | Subscriber |
| Policy | B09M000774 |
| Date of birth | 18 Oct 1968 |
| Plan | BRONZE EPO |
| Covered from | 26 Nov 2024 |
| Covered to | 4 Feb 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 |
|---|---|---|---|---|---|
| CLM0003276 | 24 Nov 2024 | 323.00 | CASCADE CARE | CARC 26 · ELIGIBILITY | 323.00 |
| CLM0003277 | 2 Nov 2024 | 129.00 | CASCADE CARE | CARC 26 · ELIGIBILITY | 129.00 |