GRACE JOHNSON
Subscriber on policy B10M000680
Claims
3
Attributed to this person
Charged
1,648.00
Total submitted
Denied
275.08
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 | GRACE JOHNSON |
| Role on the policy | Subscriber |
| Policy | B10M000680 |
| Date of birth | 13 Feb 1969 |
| Plan | BRONZE EPO |
| Covered from | 6 Mar 2025 |
| Covered to | 24 Nov 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 |
|---|---|---|---|---|---|
| CLM0002822 | 15 Nov 2025 | 765.00 | CASCADE CARE | Not denied | — |
| CLM0002821 | 15 Sep 2025 | 574.00 | CASCADE CARE | CARC 27 · ELIGIBILITY | 275.08 |
| CLM0002823 | 8 Jun 2025 | 309.00 | CASCADE CARE | Not denied | — |