VICTOR JOHNSON
Subscriber on policy B05M000320
Claims
2
Attributed to this person
Charged
964.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
30.00
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 | VICTOR JOHNSON |
| Role on the policy | Subscriber |
| Policy | B05M000320 |
| Date of birth | 25 Sep 1981 |
| Plan | SILVER HMO |
| Covered from | 15 Mar 2024 |
| Covered to | 31 May 2024 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 3 · Copay | 1 | 30.00 |
| Total | 30.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001335 | 23 Apr 2024 | 824.00 | CASCADE CARE | Not denied | — |
| CLM0001334 | 27 Mar 2024 | 140.00 | CASCADE CARE | Not denied | — |