GRACE BAKER
Dependent on policy B05M000719
Claims
3
Attributed to this person
Charged
1,491.00
Total submitted
Denied
877.61
2 denied claims
Patient responsibility
69.60
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 | GRACE BAKER |
| Role on the policy | Dependent · relationship 19 |
| Policy | B05M000719 |
| Date of birth | 5 Jul 2008 |
| Plan | BRONZE EPO |
| Covered from | 2 Jan 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 69.60 |
| Total | 69.60 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003082 | 6 Apr 2026 | 464.00 | CASCADE CARE | Not denied | — |
| CLM0003080 | 12 Nov 2025 | 274.00 | CASCADE CARE | CARC 26 · ELIGIBILITY | 124.61 |
| CLM0003081 | 12 Jul 2025 | 753.00 | CASCADE CARE | CARC 27 · ELIGIBILITY | 753.00 |