TOMAS JOHNSON
Dependent on policy B05M000494
Claims
1
Attributed to this person
Charged
694.00
Total submitted
Denied
694.00
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 | TOMAS JOHNSON |
| Role on the policy | Dependent · relationship 19 |
| Policy | B05M000494 |
| Date of birth | 17 Jun 1978 |
| 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 |
|---|---|---|---|---|---|
| CLM0002118 | 26 Nov 2025 | 694.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 694.00 |