CARLA BAKER
Dependent on policy B04M000596
Claims
2
Attributed to this person
Charged
941.00
Total submitted
Denied
189.00
1 denied claims
Patient responsibility
150.40
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 | Dependent · relationship 01 |
| Policy | B04M000596 |
| Date of birth | 7 Apr 1993 |
| Plan | SILVER HMO |
| Covered from | 17 May 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 150.40 |
| Total | 150.40 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002608 | 23 May 2025 | 189.00 | MERIDIAN HEALTH PLAN | CARC 27 · ELIGIBILITY | 189.00 |
| CLM0002609 | 7 Jun 2024 | 752.00 | MERIDIAN HEALTH PLAN | Not denied | — |