KEVIN JOHNSON
Dependent on policy B01M000332
Claims
3
Attributed to this person
Charged
1,234.00
Total submitted
Denied
25.58
2 denied claims
Patient responsibility
239.85
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 | KEVIN JOHNSON |
| Role on the policy | Dependent · relationship 01 |
| Policy | B01M000332 |
| Date of birth | 10 Jul 1961 |
| Plan | GOLD PPO |
| Covered from | 26 Mar 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 50 · Other | 1 | 239.85 |
| Total | 239.85 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001478 | 18 Oct 2025 | 381.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0001477 | 5 Sep 2024 | 484.00 | NORTHSTAR MUTUAL | CARC 16 · BILLING_ERROR | 25.58 |
| CLM0001479 | 28 Feb 2024 | 369.00 | NORTHSTAR MUTUAL | CARC 50 · MEDICAL_NECESSITY | 0.00 |