LEILA BAKER
Dependent on policy B04M000066
Claims
2
Attributed to this person
Charged
257.00
Total submitted
Denied
0.00
1 denied claims
Patient responsibility
57.85
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 | LEILA BAKER |
| Role on the policy | Dependent · relationship 19 |
| Policy | B04M000066 |
| Date of birth | 29 Jul 2019 |
| Plan | SILVER HMO |
| Covered from | 14 Jan 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 50 · Other | 1 | 57.85 |
| Total | 57.85 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000293 | 17 Jun 2026 | 89.00 | MERIDIAN HEALTH PLAN | CARC 50 · MEDICAL_NECESSITY | 0.00 |
| CLM0000292 | 6 Mar 2026 | 168.00 | MERIDIAN HEALTH PLAN | Not denied | — |