TOMAS BAKER
Dependent on policy B09M000035
Claims
3
Attributed to this person
Charged
1,391.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
74.80
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 01 |
| Policy | B09M000035 |
| Date of birth | 16 Feb 1956 |
| Plan | SILVER HMO |
| Covered from | 16 Dec 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 74.80 |
| Total | 74.80 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000170 | 10 Jun 2026 | 374.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0000169 | 9 Oct 2025 | 378.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0000168 | 11 Jun 2025 | 639.00 | MERIDIAN HEALTH PLAN | Not denied | — |