ELENA JOHNSON
Dependent on policy B03M000198
Claims
2
Attributed to this person
Charged
767.00
Total submitted
Denied
252.00
1 denied claims
Patient responsibility
77.25
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 | ELENA JOHNSON |
| Role on the policy | Dependent · relationship 01 |
| Policy | B03M000198 |
| Date of birth | 31 Aug 1976 |
| Plan | GOLD PPO |
| Covered from | 15 Aug 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 77.25 |
| Total | 77.25 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000822 | 28 Jul 2025 | 515.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0000821 | 21 Apr 2025 | 252.00 | NORTHSTAR MUTUAL | CARC 11 · CODING | 252.00 |