SOFIA BAKER
Subscriber on policy B10M000696
Claims
3
Attributed to this person
Charged
1,588.00
Total submitted
Denied
319.71
2 denied claims
Patient responsibility
15.00
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 | SOFIA BAKER |
| Role on the policy | Subscriber |
| Policy | B10M000696 |
| Date of birth | 25 Jul 1996 |
| Plan | PLATINUM PPO |
| Covered from | 15 Mar 2024 |
| Covered to | 20 Jun 2024 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 3 · Copay | 1 | 15.00 |
| Total | 15.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002913 | 29 Jun 2024 | 124.00 | MERIDIAN HEALTH PLAN | CARC 27 · ELIGIBILITY | 124.00 |
| CLM0002915 | 22 Apr 2024 | 780.00 | MERIDIAN HEALTH PLAN | CARC 27 · ELIGIBILITY | 195.71 |
| CLM0002914 | 18 Apr 2024 | 684.00 | MERIDIAN HEALTH PLAN | Not denied | — |