GRACE BAKER
Dependent on policy B04M000150
Claims
1
Attributed to this person
Charged
585.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
87.75
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 | GRACE BAKER |
| Role on the policy | Dependent · relationship 19 |
| Policy | B04M000150 |
| Date of birth | 27 Sep 1993 |
| Plan | BRONZE EPO |
| Covered from | 3 Jun 2024 |
| Covered to | 12 Oct 2024 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 87.75 |
| Total | 87.75 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000690 | 19 Jul 2024 | 585.00 | MERIDIAN HEALTH PLAN | Not denied | — |