FIONA JOHNSON
Dependent on policy B03M000826
Claims
2
Attributed to this person
Charged
646.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
42.60
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 | FIONA JOHNSON |
| Role on the policy | Dependent · relationship 01 |
| Policy | B03M000826 |
| Date of birth | 2 Feb 1983 |
| Plan | GOLD PPO |
| Covered from | 6 Jan 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 42.60 |
| Total | 42.60 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003551 | 16 Oct 2024 | 213.00 | CASCADE CARE | Not denied | — |
| CLM0003552 | 6 May 2024 | 433.00 | CASCADE CARE | Not denied | — |