GRACE BAKER
Dependent on policy B10M000131
Claims
1
Attributed to this person
Charged
114.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
22.80
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 | GRACE BAKER |
| Role on the policy | Dependent · relationship 01 |
| Policy | B10M000131 |
| Date of birth | 1 Aug 1977 |
| Plan | PLATINUM PPO |
| Covered from | 5 May 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 22.80 |
| Total | 22.80 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000544 | 24 Aug 2024 | 114.00 | MERIDIAN HEALTH PLAN | Not denied | — |