DAVID OKAFOR
Dependent on policy B06M000891
Claims
2
Attributed to this person
Charged
439.00
Total submitted
Denied
186.00
1 denied claims
Patient responsibility
50.60
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 | DAVID OKAFOR |
| Role on the policy | Dependent · relationship 19 |
| Policy | B06M000891 |
| Date of birth | 20 Feb 1999 |
| Plan | PLATINUM PPO |
| Covered from | 20 Jan 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 50.60 |
| Total | 50.60 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003880 | 23 May 2025 | 253.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0003879 | 12 Jan 2025 | 186.00 | NORTHSTAR MUTUAL | CARC 26 · ELIGIBILITY | 186.00 |