DAVID JOHNSON
Dependent on policy B10M000305
Claims
2
Attributed to this person
Charged
977.00
Total submitted
Denied
779.00
1 denied claims
Patient responsibility
29.70
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 | DAVID JOHNSON |
| Role on the policy | Dependent · relationship 01 |
| Policy | B10M000305 |
| Date of birth | 3 Nov 1977 |
| Plan | GOLD PPO |
| Covered from | 22 Jan 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 29.70 |
| Total | 29.70 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001280 | 24 Jun 2026 | 779.00 | CASCADE CARE | CARC 16 · BILLING_ERROR | 779.00 |
| CLM0001281 | 27 Oct 2025 | 198.00 | CASCADE CARE | Not denied | — |