CARLA JOHNSON
Subscriber on policy B05M000494
Claims
2
Attributed to this person
Charged
863.00
Total submitted
Denied
215.00
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 | CARLA JOHNSON |
| Role on the policy | Subscriber |
| Policy | B05M000494 |
| Date of birth | 1 Mar 1957 |
| Plan | PLATINUM PPO |
| Covered from | 27 Mar 2025 |
| Covered to | 22 Nov 2025 |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002114 | 19 Sep 2025 | 648.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0002113 | 25 Mar 2025 | 215.00 | NORTHSTAR MUTUAL | CARC 26 · ELIGIBILITY | 215.00 |