CARLA BAKER
Subscriber on policy B03M000040
Claims
2
Attributed to this person
Charged
1,155.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
123.80
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 | CARLA BAKER |
| Role on the policy | Subscriber |
| Policy | B03M000040 |
| Date of birth | 22 Mar 1965 |
| Plan | BRONZE EPO |
| Covered from | 18 Mar 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 123.80 |
| Total | 123.80 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000176 | 22 Jun 2026 | 619.00 | CASCADE CARE | Not denied | — |
| CLM0000175 | 9 Jul 2024 | 536.00 | CASCADE CARE | Not denied | — |