DAVID JOHNSON
Dependent on policy B02M000453
Claims
3
Attributed to this person
Charged
1,306.00
Total submitted
Denied
645.00
2 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 | DAVID JOHNSON |
| Role on the policy | Dependent · relationship 01 |
| Policy | B02M000453 |
| Date of birth | 10 Sep 1980 |
| Plan | SILVER HMO |
| Covered from | 22 Oct 2024 |
| Covered to | open |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001930 | 29 May 2026 | 198.00 | CASCADE CARE | CARC 18 · DUPLICATE | 198.00 |
| CLM0001929 | 8 Jan 2026 | 661.00 | CASCADE CARE | Not denied | — |
| CLM0001931 | 9 Nov 2024 | 447.00 | CASCADE CARE | CARC 27 · ELIGIBILITY | 447.00 |