CARLA JOHNSON
Dependent on policy B09M000818
Claims
1
Attributed to this person
Charged
836.00
Total submitted
Denied
217.96
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 | CARLA JOHNSON |
| Role on the policy | Dependent · relationship 19 |
| Policy | B09M000818 |
| Date of birth | 11 Sep 2005 |
| Plan | PLATINUM PPO |
| Covered from | 5 Oct 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 |
|---|---|---|---|---|---|
| CLM0003477 | 22 Dec 2024 | 836.00 | CASCADE CARE | CARC 50 · MEDICAL_NECESSITY | 217.96 |