SOFIA JOHNSON
Subscriber on policy B02M000575
Claims
3
Attributed to this person
Charged
1,337.00
Total submitted
Denied
164.00
1 denied claims
Patient responsibility
80.00
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 | SOFIA JOHNSON |
| Role on the policy | Subscriber |
| Policy | B02M000575 |
| Date of birth | 20 Feb 1951 |
| Plan | SILVER HMO |
| Covered from | 16 Feb 2025 |
| Covered to | 20 Apr 2025 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 80.00 |
| Total | 80.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002409 | 24 May 2025 | 164.00 | CASCADE CARE | CARC 27 · ELIGIBILITY | 164.00 |
| CLM0002411 | 30 Jan 2025 | 773.00 | CASCADE CARE | Not denied | — |
| CLM0002410 | 20 Jan 2025 | 400.00 | CASCADE CARE | Not denied | — |