GRACE BAKER
Dependent on policy B09M000148
Claims
2
Attributed to this person
Charged
1,299.00
Total submitted
Denied
757.00
1 denied claims
Patient responsibility
81.30
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 | GRACE BAKER |
| Role on the policy | Dependent · relationship 19 |
| Policy | B09M000148 |
| Date of birth | 4 May 2006 |
| Plan | GOLD PPO |
| Covered from | 1 Feb 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 81.30 |
| Total | 81.30 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000626 | 26 Jan 2025 | 757.00 | CASCADE CARE | CARC 197 · AUTHORIZATION | 757.00 |
| CLM0000625 | 10 Jun 2024 | 542.00 | CASCADE CARE | Not denied | — |