WENDY JOHNSON
Dependent on policy B05M000320
Claims
3
Attributed to this person
Charged
1,827.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
110.40
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 | WENDY JOHNSON |
| Role on the policy | Dependent · relationship 19 |
| Policy | B05M000320 |
| Date of birth | 23 Aug 2017 |
| Plan | SILVER HMO |
| Covered from | 15 Mar 2024 |
| Covered to | 31 May 2024 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 110.40 |
| Total | 110.40 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001339 | 8 Apr 2024 | 751.00 | CASCADE CARE | Not denied | — |
| CLM0001338 | 22 Mar 2024 | 524.00 | CASCADE CARE | Not denied | — |
| CLM0001340 | 20 Mar 2024 | 552.00 | CASCADE CARE | Not denied | — |