FIONA JOHNSON
Subscriber on policy B05M000076
Claims
2
Attributed to this person
Charged
1,101.00
Total submitted
Denied
0.00
1 denied claims
Patient responsibility
489.15
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 | FIONA JOHNSON |
| Role on the policy | Subscriber |
| Policy | B05M000076 |
| Date of birth | 2 Mar 1992 |
| Plan | PLATINUM PPO |
| Covered from | 5 Apr 2025 |
| Covered to | 14 Nov 2025 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 96 · Other | 1 | 421.20 |
| CARC 1 · Deductible | 1 | 67.95 |
| Total | 489.15 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000351 | 1 Sep 2025 | 453.00 | CASCADE CARE | Not denied | — |
| CLM0000352 | 30 May 2025 | 648.00 | CASCADE CARE | CARC 96 · NON_COVERED | 0.00 |