OMAR BAKER
Dependent on policy B04M000605
Claims
1
Attributed to this person
Charged
392.00
Total submitted
Denied
0.00
1 denied claims
Patient responsibility
254.80
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 | OMAR BAKER |
| Role on the policy | Dependent · relationship 01 |
| Policy | B04M000605 |
| Date of birth | 23 Oct 1949 |
| Plan | PLATINUM PPO |
| Covered from | 12 Feb 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 96 · Other | 1 | 254.80 |
| Total | 254.80 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002644 | 29 Dec 2025 | 392.00 | CASCADE CARE | CARC 96 · NON_COVERED | 0.00 |