DAVID BAKER
Dependent on policy B04M000545
Claims
2
Attributed to this person
Charged
725.00
Total submitted
Denied
513.00
1 denied claims
Patient responsibility
31.80
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 | DAVID BAKER |
| Role on the policy | Dependent · relationship 01 |
| Policy | B04M000545 |
| Date of birth | 3 Jan 1983 |
| Plan | BRONZE EPO |
| Covered from | 20 Jan 2024 |
| Covered to | 9 Apr 2024 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 31.80 |
| Total | 31.80 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002396 | 8 May 2024 | 513.00 | CASCADE CARE | CARC 27 · ELIGIBILITY | 513.00 |
| CLM0002395 | 18 Mar 2024 | 212.00 | CASCADE CARE | Not denied | — |