TOMAS BAKER
Dependent on policy B03M000478
Claims
1
Attributed to this person
Charged
629.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
0.00
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 | TOMAS BAKER |
| Role on the policy | Dependent · relationship 01 |
| Policy | B03M000478 |
| Date of birth | 27 Dec 2000 |
| Plan | BRONZE EPO |
| Covered from | 27 Sep 2024 |
| Covered to | 23 May 2025 |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001993 | 2 Sep 2024 | 629.00 | NORTHSTAR MUTUAL | Not denied | — |