HENRY BAKER
Subscriber on policy B04M000509
Claims
1
Attributed to this person
Charged
252.00
Total submitted
Denied
77.50
1 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 | HENRY BAKER |
| Role on the policy | Subscriber |
| Policy | B04M000509 |
| Date of birth | 24 Oct 1972 |
| Plan | PLATINUM PPO |
| Covered from | 15 Jan 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 |
|---|---|---|---|---|---|
| CLM0002192 | 5 May 2024 | 252.00 | CASCADE CARE | CARC 27 · ELIGIBILITY | 77.50 |