GRACE JOHNSON
Dependent on policy B03M000795
Claims
3
Attributed to this person
Charged
1,925.00
Total submitted
Denied
1,415.00
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 | GRACE JOHNSON |
| Role on the policy | Dependent · relationship 19 |
| Policy | B03M000795 |
| Date of birth | 9 Jul 2009 |
| Plan | PLATINUM PPO |
| Covered from | 15 Nov 2024 |
| Covered to | 13 Aug 2025 |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003398 | 10 Jun 2025 | 510.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0003399 | 12 Apr 2025 | 641.00 | MERIDIAN HEALTH PLAN | CARC 29 · TIMELY_FILING | 641.00 |
| CLM0003397 | 15 Dec 2024 | 774.00 | MERIDIAN HEALTH PLAN | CARC 29 · TIMELY_FILING | 774.00 |