WENDY BAKER
Dependent on policy B03M000629
Claims
3
Attributed to this person
Charged
1,734.00
Total submitted
Denied
0.00
1 denied claims
Patient responsibility
417.95
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 | WENDY BAKER |
| Role on the policy | Dependent · relationship 19 |
| Policy | B03M000629 |
| Date of birth | 14 Nov 2000 |
| Plan | SILVER HMO |
| Covered from | 3 May 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 96 · Other | 1 | 417.95 |
| Total | 417.95 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002596 | 21 Jul 2026 | 643.00 | NORTHSTAR MUTUAL | CARC 96 · NON_COVERED | 0.00 |
| CLM0002595 | 25 May 2026 | 884.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0002597 | 6 May 2024 | 207.00 | NORTHSTAR MUTUAL | Not denied | — |