TOMAS JOHNSON
Dependent on policy B05M000771
Claims
2
Attributed to this person
Charged
1,040.00
Total submitted
Denied
151.00
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 | TOMAS JOHNSON |
| Role on the policy | Dependent · relationship 19 |
| Policy | B05M000771 |
| Date of birth | 9 Jul 2012 |
| Plan | PLATINUM PPO |
| Covered from | 1 Apr 2025 |
| Covered to | 26 Jul 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 |
|---|---|---|---|---|---|
| CLM0003300 | 15 Aug 2025 | 151.00 | CASCADE CARE | CARC 27 · ELIGIBILITY | 151.00 |
| CLM0003301 | 9 May 2025 | 889.00 | CASCADE CARE | Not denied | — |