CARLA JOHNSON
Dependent on policy B05M000866
Claims
2
Attributed to this person
Charged
1,172.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
118.20
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 | CARLA JOHNSON |
| Role on the policy | Dependent · relationship 19 |
| Policy | B05M000866 |
| Date of birth | 31 Jan 1995 |
| Plan | BRONZE EPO |
| Covered from | 30 Mar 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 118.20 |
| Total | 118.20 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003679 | 24 Nov 2025 | 788.00 | CASCADE CARE | Not denied | — |
| CLM0003678 | 30 Aug 2025 | 384.00 | CASCADE CARE | Not denied | — |