KEVIN BAKER
Subscriber on policy B04M000214
Claims
3
Attributed to this person
Charged
1,047.00
Total submitted
Denied
441.00
1 denied claims
Patient responsibility
95.00
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 | KEVIN BAKER |
| Role on the policy | Subscriber |
| Policy | B04M000214 |
| Date of birth | 10 Jun 1958 |
| Plan | GOLD PPO |
| Covered from | 25 May 2024 |
| Covered to | 13 Aug 2024 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 95.00 |
| Total | 95.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000944 | 27 Sep 2024 | 441.00 | CASCADE CARE | CARC 27 · ELIGIBILITY | 441.00 |
| CLM0000943 | 24 Sep 2024 | 131.00 | CASCADE CARE | Not denied | — |
| CLM0000945 | 21 May 2024 | 475.00 | CASCADE CARE | Not denied | — |