ELENA BAKER
Dependent on policy B10M000828
Claims
3
Attributed to this person
Charged
1,231.00
Total submitted
Denied
493.00
2 denied claims
Patient responsibility
114.40
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 | Dependent · relationship 01 |
| Policy | B10M000828 |
| Date of birth | 21 Feb 1963 |
| Plan | BRONZE EPO |
| Covered from | 17 Apr 2024 |
| Covered to | 7 Oct 2024 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 96 · Other | 1 | 114.40 |
| Total | 114.40 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003509 | 24 Oct 2024 | 493.00 | CASCADE CARE | CARC 27 · ELIGIBILITY | 493.00 |
| CLM0003511 | 28 Jun 2024 | 562.00 | CASCADE CARE | Not denied | — |
| CLM0003510 | 4 Jun 2024 | 176.00 | CASCADE CARE | CARC 96 · NON_COVERED | 0.00 |