ELENA BAKER
Subscriber on policy B09M000365
Claims
3
Attributed to this person
Charged
1,061.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
53.00
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 | Subscriber |
| Policy | B09M000365 |
| Date of birth | 2 Dec 1958 |
| Plan | PLATINUM PPO |
| Covered from | 3 May 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 53.00 |
| Total | 53.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001507 | 14 Mar 2026 | 368.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0001509 | 7 Apr 2025 | 265.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0001508 | 22 Feb 2025 | 428.00 | NORTHSTAR MUTUAL | Not denied | — |