LEILA JOHNSON
Dependent on policy B10M000715
Claims
1
Attributed to this person
Charged
511.00
Total submitted
Denied
0.00
1 denied claims
Patient responsibility
332.15
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 | LEILA JOHNSON |
| Role on the policy | Dependent · relationship 01 |
| Policy | B10M000715 |
| Date of birth | 14 Oct 1967 |
| Plan | GOLD PPO |
| Covered from | 12 Feb 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 96 · Other | 1 | 332.15 |
| Total | 332.15 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003002 | 17 Dec 2024 | 511.00 | MERIDIAN HEALTH PLAN | CARC 96 · NON_COVERED | 0.00 |