BRIAN JOHNSON
Subscriber on policy B03M000118
Claims
2
Attributed to this person
Charged
1,369.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
161.20
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 | BRIAN JOHNSON |
| Role on the policy | Subscriber |
| Policy | B03M000118 |
| Date of birth | 13 Jun 1983 |
| Plan | SILVER HMO |
| Covered from | 30 Jun 2024 |
| Covered to | 8 Nov 2024 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 161.20 |
| Total | 161.20 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000459 | 8 Jun 2024 | 806.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0000460 | 1 Jun 2024 | 563.00 | MERIDIAN HEALTH PLAN | Not denied | — |