ELENA BAKER
Dependent on policy B08M000530
Claims
2
Attributed to this person
Charged
951.00
Total submitted
Denied
891.00
2 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 | ELENA BAKER |
| Role on the policy | Dependent · relationship 01 |
| Policy | B08M000530 |
| Date of birth | 12 Apr 1977 |
| Plan | SILVER HMO |
| Covered from | 28 Mar 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 50 · Other | 1 | 39.00 |
| Total | 39.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002426 | 4 May 2025 | 891.00 | NORTHSTAR MUTUAL | CARC 50 · MEDICAL_NECESSITY | 891.00 |
| CLM0002425 | 21 Sep 2024 | 60.00 | NORTHSTAR MUTUAL | CARC 50 · MEDICAL_NECESSITY | 0.00 |