CARLA JOHNSON
Subscriber on policy B04M000689
Claims
1
Attributed to this person
Charged
298.00
Total submitted
Denied
146.23
1 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 | Subscriber |
| Policy | B04M000689 |
| Date of birth | 26 Nov 1953 |
| Plan | SILVER HMO |
| Covered from | 14 Nov 2024 |
| Covered to | open |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002998 | 21 Dec 2025 | 298.00 | MERIDIAN HEALTH PLAN | CARC 16 · BILLING_ERROR | 146.23 |