UMA BAKER
Dependent on policy B09M000116
Claims
1
Attributed to this person
Charged
269.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
40.35
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 19 |
| Policy | B09M000116 |
| Date of birth | 17 Jul 1984 |
| Plan | SILVER HMO |
| Covered from | 9 Sep 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 40.35 |
| Total | 40.35 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000479 | 26 Jun 2026 | 269.00 | NORTHSTAR MUTUAL | Not denied | — |