IVAN JOHNSON
Dependent on policy B04M000514
Claims
2
Attributed to this person
Charged
839.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
20.00
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 | IVAN JOHNSON |
| Role on the policy | Dependent · relationship 01 |
| Policy | B04M000514 |
| Date of birth | 17 Apr 1991 |
| Plan | GOLD PPO |
| Covered from | 10 Jul 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 3 · Copay | 1 | 20.00 |
| Total | 20.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002219 | 26 Jan 2026 | 698.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0002218 | 25 Dec 2024 | 141.00 | NORTHSTAR MUTUAL | Not denied | — |