TOMAS JOHNSON
Subscriber on policy B04M000266
Claims
3
Attributed to this person
Charged
1,036.00
Total submitted
Denied
642.00
2 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 | TOMAS JOHNSON |
| Role on the policy | Subscriber |
| Policy | B04M000266 |
| Date of birth | 12 Mar 1951 |
| Plan | SILVER HMO |
| Covered from | 10 Jan 2025 |
| Covered to | 16 Jun 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 |
|---|---|---|---|---|---|
| CLM0001150 | 4 Jul 2025 | 580.00 | MERIDIAN HEALTH PLAN | CARC 27 · ELIGIBILITY | 580.00 |
| CLM0001151 | 27 Jun 2025 | 62.00 | MERIDIAN HEALTH PLAN | CARC 26 · ELIGIBILITY | 62.00 |
| CLM0001149 | 30 May 2025 | 394.00 | MERIDIAN HEALTH PLAN | Not denied | — |