CARLA JOHNSON
Dependent on policy B03M000793
Claims
3
Attributed to this person
Charged
1,491.00
Total submitted
Denied
0.00
0 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 | CARLA JOHNSON |
| Role on the policy | Dependent · relationship 19 |
| Policy | B03M000793 |
| Date of birth | 22 May 2021 |
| Plan | BRONZE EPO |
| Covered from | 24 Aug 2024 |
| Covered to | 19 Jan 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 |
|---|---|---|---|---|---|
| CLM0003384 | 11 Mar 2025 | 531.00 | CASCADE CARE | Not denied | — |
| CLM0003383 | 25 Feb 2025 | 459.00 | CASCADE CARE | Not denied | — |
| CLM0003382 | 11 Oct 2024 | 501.00 | CASCADE CARE | Not denied | — |