UMA BAKER
Dependent on policy B04M000743
Claims
1
Attributed to this person
Charged
615.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
0.00
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 | UMA BAKER |
| Role on the policy | Dependent · relationship 19 |
| Policy | B04M000743 |
| Date of birth | 19 Aug 2020 |
| Plan | GOLD PPO |
| Covered from | 5 Oct 2024 |
| Covered to | open |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003254 | 24 Oct 2024 | 615.00 | NORTHSTAR MUTUAL | Not denied | — |