LEILA JOHNSON
Dependent on policy B04M000558
Claims
1
Attributed to this person
Charged
614.00
Total submitted
Denied
614.00
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 | LEILA JOHNSON |
| Role on the policy | Dependent · relationship 19 |
| Policy | B04M000558 |
| Date of birth | 19 Jul 2010 |
| Plan | GOLD PPO |
| Covered from | 8 Feb 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 |
|---|---|---|---|---|---|
| CLM0002452 | 4 Feb 2026 | 614.00 | CASCADE CARE | CARC 27 · ELIGIBILITY | 614.00 |