ELENA JOHNSON
Dependent on policy B01M000748
Claims
3
Attributed to this person
Charged
1,251.00
Total submitted
Denied
407.00
1 denied claims
Patient responsibility
96.30
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 | ELENA JOHNSON |
| Role on the policy | Dependent · relationship 01 |
| Policy | B01M000748 |
| Date of birth | 30 Nov 1997 |
| Plan | GOLD PPO |
| Covered from | 4 Mar 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 96.30 |
| Total | 96.30 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003327 | 11 May 2026 | 202.00 | CASCADE CARE | Not denied | — |
| CLM0003326 | 26 Mar 2026 | 407.00 | CASCADE CARE | CARC 29 · TIMELY_FILING | 407.00 |
| CLM0003325 | 19 Jun 2025 | 642.00 | CASCADE CARE | Not denied | — |