TOMAS BAKER
Dependent on policy B04M000093
Claims
3
Attributed to this person
Charged
897.00
Total submitted
Denied
0.00
1 denied claims
Patient responsibility
296.40
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 | TOMAS BAKER |
| Role on the policy | Dependent · relationship 19 |
| Policy | B04M000093 |
| Date of birth | 24 Jul 1991 |
| Plan | PLATINUM PPO |
| Covered from | 9 Apr 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 50 · Other | 1 | 296.40 |
| Total | 296.40 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000424 | 18 Feb 2026 | 60.00 | CASCADE CARE | Not denied | — |
| CLM0000423 | 9 Jan 2026 | 381.00 | CASCADE CARE | Not denied | — |
| CLM0000425 | 9 Oct 2025 | 456.00 | CASCADE CARE | CARC 50 · MEDICAL_NECESSITY | 0.00 |