GRACE JOHNSON
Subscriber on policy B02M000858
Claims
3
Attributed to this person
Charged
1,044.00
Total submitted
Denied
26.55
2 denied claims
Patient responsibility
509.10
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 | B02M000858 |
| Date of birth | 23 Mar 1999 |
| Plan | BRONZE EPO |
| Covered from | 20 Apr 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 96 · Other | 1 | 490.10 |
| CARC 2 · Coinsurance | 1 | 19.00 |
| Total | 509.10 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003575 | 4 Aug 2026 | 195.00 | MERIDIAN HEALTH PLAN | CARC 11 · CODING | 26.55 |
| CLM0003576 | 25 Mar 2026 | 754.00 | MERIDIAN HEALTH PLAN | CARC 96 · NON_COVERED | 0.00 |
| CLM0003577 | 1 Dec 2025 | 95.00 | MERIDIAN HEALTH PLAN | Not denied | — |