TOMAS BAKER
Dependent on policy B07M000597
Claims
2
Attributed to this person
Charged
369.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
73.80
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 BAKER |
| Role on the policy | Dependent · relationship 19 |
| Policy | B07M000597 |
| Date of birth | 13 May 1987 |
| Plan | PLATINUM PPO |
| Covered from | 27 Jan 2025 |
| Covered to | 31 Aug 2025 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 2 | 73.80 |
| Total | 73.80 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002509 | 15 Oct 2025 | 121.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0002508 | 1 Mar 2025 | 248.00 | MERIDIAN HEALTH PLAN | Not denied | — |