GRACE JOHNSON
Dependent on policy B03M000705
Claims
2
Attributed to this person
Charged
888.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
30.00
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 | B03M000705 |
| Date of birth | 18 Dec 2013 |
| Plan | PLATINUM PPO |
| Covered from | 2 Feb 2025 |
| Covered to | 13 Sep 2025 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 3 · Copay | 1 | 30.00 |
| Total | 30.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002939 | 24 Apr 2025 | 512.00 | CASCADE CARE | Not denied | — |
| CLM0002940 | 26 Feb 2025 | 376.00 | CASCADE CARE | Not denied | — |