AMARA BAKER
Subscriber on policy B10M000811
Claims
1
Attributed to this person
Charged
799.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
159.80
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 | AMARA BAKER |
| Role on the policy | Subscriber |
| Policy | B10M000811 |
| Date of birth | 21 Jan 1975 |
| Plan | GOLD PPO |
| Covered from | 17 Jan 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 159.80 |
| Total | 159.80 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003432 | 15 Dec 2024 | 799.00 | NORTHSTAR MUTUAL | Not denied | — |