HENRY JOHNSON
Subscriber on policy B01M000398
Claims
3
Attributed to this person
Charged
1,101.00
Total submitted
Denied
0.00
2 denied claims
Patient responsibility
644.15
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 | HENRY JOHNSON |
| Role on the policy | Subscriber |
| Policy | B01M000398 |
| Date of birth | 30 Jan 1983 |
| Plan | PLATINUM PPO |
| Covered from | 26 Jan 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 96 · Other | 2 | 644.15 |
| Total | 644.15 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001766 | 28 Jun 2026 | 468.00 | NORTHSTAR MUTUAL | CARC 96 · NON_COVERED | 0.00 |
| CLM0001768 | 17 Mar 2025 | 523.00 | NORTHSTAR MUTUAL | CARC 96 · NON_COVERED | 0.00 |
| CLM0001767 | 10 Mar 2025 | 110.00 | NORTHSTAR MUTUAL | Not denied | — |