KEVIN JOHNSON
Dependent on policy B05M000355
Claims
3
Attributed to this person
Charged
1,911.00
Total submitted
Denied
202.48
1 denied claims
Patient responsibility
250.50
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 | KEVIN JOHNSON |
| Role on the policy | Dependent · relationship 01 |
| Policy | B05M000355 |
| Date of birth | 8 Jul 1980 |
| Plan | SILVER HMO |
| Covered from | 14 Feb 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 160.80 |
| CARC 1 · Deductible | 1 | 89.70 |
| Total | 250.50 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001523 | 25 Jan 2026 | 804.00 | CASCADE CARE | Not denied | — |
| CLM0001524 | 21 Jan 2026 | 598.00 | CASCADE CARE | Not denied | — |
| CLM0001522 | 8 Jan 2026 | 509.00 | CASCADE CARE | CARC 197 · AUTHORIZATION | 202.48 |