DAVID JOHNSON
Dependent on policy B03M000494
Claims
3
Attributed to this person
Charged
976.00
Total submitted
Denied
81.12
1 denied claims
Patient responsibility
43.00
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 | DAVID JOHNSON |
| Role on the policy | Dependent · relationship 01 |
| Policy | B03M000494 |
| Date of birth | 13 Mar 1961 |
| Plan | SILVER HMO |
| Covered from | 22 Nov 2024 |
| Covered to | 18 Feb 2025 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 43.00 |
| Total | 43.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002053 | 13 Mar 2025 | 215.00 | CASCADE CARE | Not denied | — |
| CLM0002054 | 3 Jan 2025 | 277.00 | CASCADE CARE | CARC 50 · MEDICAL_NECESSITY | 81.12 |
| CLM0002052 | 25 Dec 2024 | 484.00 | CASCADE CARE | Not denied | — |