GRACE JOHNSON
Subscriber on policy B02M000130
Claims
2
Attributed to this person
Charged
1,135.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
86.20
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 | B02M000130 |
| Date of birth | 25 May 1982 |
| Plan | BRONZE EPO |
| Covered from | 7 Feb 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 86.20 |
| Total | 86.20 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000595 | 7 Jan 2026 | 704.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0000596 | 26 Feb 2025 | 431.00 | NORTHSTAR MUTUAL | Not denied | — |