HENRY JOHNSON
Subscriber on policy B02M000453
Claims
3
Attributed to this person
Charged
1,215.00
Total submitted
Denied
400.00
1 denied claims
Patient responsibility
71.85
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 | HENRY JOHNSON |
| Role on the policy | Subscriber |
| Policy | B02M000453 |
| Date of birth | 12 Mar 1973 |
| Plan | SILVER HMO |
| Covered from | 22 Oct 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 71.85 |
| Total | 71.85 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001927 | 24 Jan 2026 | 336.00 | CASCADE CARE | Not denied | — |
| CLM0001926 | 19 Nov 2025 | 479.00 | CASCADE CARE | Not denied | — |
| CLM0001928 | 17 Jun 2025 | 400.00 | CASCADE CARE | CARC 27 · ELIGIBILITY | 400.00 |