HENRY BAKER
Subscriber on policy B08M000159
Claims
3
Attributed to this person
Charged
1,477.00
Total submitted
Denied
706.00
1 denied claims
Patient responsibility
76.60
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 | HENRY BAKER |
| Role on the policy | Subscriber |
| Policy | B08M000159 |
| Date of birth | 23 Jan 1993 |
| Plan | SILVER HMO |
| Covered from | 16 May 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 76.60 |
| Total | 76.60 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000726 | 9 Jan 2026 | 388.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0000724 | 3 Oct 2025 | 383.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0000725 | 30 May 2025 | 706.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 706.00 |