ZARA JOHNSON
Dependent on policy B04M000040
Claims
1
Attributed to this person
Charged
656.00
Total submitted
Denied
656.00
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 | ZARA JOHNSON |
| Role on the policy | Dependent · relationship 19 |
| Policy | B04M000040 |
| Date of birth | 19 Jul 2023 |
| Plan | SILVER HMO |
| Covered from | 27 Apr 2025 |
| 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 |
|---|---|---|---|---|---|
| CLM0000191 | 7 Dec 2025 | 656.00 | CASCADE CARE | CARC 96 · NON_COVERED | 656.00 |