ZARA JOHNSON
Dependent on policy B05M000759
Claims
1
Attributed to this person
Charged
817.00
Total submitted
Denied
220.97
1 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 | ZARA JOHNSON |
| Role on the policy | Dependent · relationship 19 |
| Policy | B05M000759 |
| Date of birth | 7 Dec 2003 |
| Plan | BRONZE EPO |
| Covered from | 28 Nov 2024 |
| Covered to | 19 Aug 2025 |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003256 | 12 Jan 2025 | 817.00 | CASCADE CARE | CARC 197 · AUTHORIZATION | 220.97 |