IVAN JOHNSON
Subscriber on policy B06M000331
Claims
2
Attributed to this person
Charged
376.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
39.00
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 | IVAN JOHNSON |
| Role on the policy | Subscriber |
| Policy | B06M000331 |
| Date of birth | 7 Jun 1969 |
| Plan | GOLD PPO |
| Covered from | 17 Aug 2024 |
| Covered to | 18 Oct 2024 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 39.00 |
| Total | 39.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001500 | 25 Nov 2024 | 116.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0001499 | 28 Oct 2024 | 260.00 | MERIDIAN HEALTH PLAN | Not denied | — |