CARLA JOHNSON
Dependent on policy B03M000008
Claims
2
Attributed to this person
Charged
832.00
Total submitted
Denied
400.00
2 denied claims
Patient responsibility
280.80
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 | CARLA JOHNSON |
| Role on the policy | Dependent · relationship 01 |
| Policy | B03M000008 |
| Date of birth | 14 Nov 1984 |
| Plan | PLATINUM PPO |
| Covered from | 22 Jan 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 50 · Other | 1 | 280.80 |
| Total | 280.80 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000048 | 22 Jul 2026 | 400.00 | MERIDIAN HEALTH PLAN | CARC 27 · ELIGIBILITY | 400.00 |
| CLM0000047 | 21 Apr 2025 | 432.00 | MERIDIAN HEALTH PLAN | CARC 50 · MEDICAL_NECESSITY | 0.00 |