PRIYA JOHNSON
Dependent on policy B05M000797
Claims
2
Attributed to this person
Charged
343.00
Total submitted
Denied
55.39
1 denied claims
Patient responsibility
26.10
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 | PRIYA JOHNSON |
| Role on the policy | Dependent · relationship 01 |
| Policy | B05M000797 |
| Date of birth | 28 Sep 1944 |
| Plan | BRONZE EPO |
| Covered from | 12 Jun 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 26.10 |
| Total | 26.10 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003380 | 8 Feb 2026 | 169.00 | CASCADE CARE | CARC 50 · MEDICAL_NECESSITY | 55.39 |
| CLM0003379 | 27 Dec 2024 | 174.00 | CASCADE CARE | Not denied | — |