IVAN JOHNSON
Dependent on policy B03M000632
Claims
1
Attributed to this person
Charged
502.00
Total submitted
Denied
0.00
1 denied claims
Patient responsibility
326.30
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 | IVAN JOHNSON |
| Role on the policy | Dependent · relationship 19 |
| Policy | B03M000632 |
| Date of birth | 9 May 1989 |
| Plan | PLATINUM PPO |
| Covered from | 12 Mar 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 50 · Other | 1 | 326.30 |
| Total | 326.30 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002609 | 17 Dec 2024 | 502.00 | MERIDIAN HEALTH PLAN | CARC 50 · MEDICAL_NECESSITY | 0.00 |