UMA BAKER
Dependent on policy B08M000880
Claims
2
Attributed to this person
Charged
391.00
Total submitted
Denied
134.00
1 denied claims
Patient responsibility
25.00
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 | UMA BAKER |
| Role on the policy | Dependent · relationship 01 |
| Policy | B08M000880 |
| Date of birth | 25 Nov 1973 |
| Plan | PLATINUM PPO |
| Covered from | 2 Feb 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 3 · Copay | 1 | 25.00 |
| Total | 25.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003935 | 28 Oct 2024 | 257.00 | CASCADE CARE | Not denied | — |
| CLM0003936 | 15 Oct 2024 | 134.00 | CASCADE CARE | CARC 27 · ELIGIBILITY | 134.00 |