HENRY JOHNSON
Dependent on policy B01M000398
Claims
3
Attributed to this person
Charged
1,597.00
Total submitted
Denied
700.00
2 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 | HENRY JOHNSON |
| Role on the policy | Dependent · relationship 01 |
| Policy | B01M000398 |
| Date of birth | 12 Oct 1981 |
| Plan | PLATINUM PPO |
| Covered from | 26 Jan 2025 |
| Covered to | open |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001770 | 17 Jan 2026 | 80.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 80.00 |
| CLM0001771 | 22 Sep 2025 | 620.00 | NORTHSTAR MUTUAL | CARC 16 · BILLING_ERROR | 620.00 |
| CLM0001769 | 25 Jul 2025 | 897.00 | NORTHSTAR MUTUAL | Not denied | — |