DAVID OKAFOR
Dependent on policy B06M000289
Claims
3
Attributed to this person
Charged
1,863.00
Total submitted
Denied
895.00
1 denied claims
Patient responsibility
100.15
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 01 |
| Policy | B06M000289 |
| Date of birth | 7 Mar 1969 |
| Plan | BRONZE EPO |
| Covered from | 2 Aug 2024 |
| Covered to | 7 Nov 2024 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 60.15 |
| CARC 3 · Copay | 1 | 40.00 |
| Total | 100.15 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001339 | 20 Nov 2024 | 895.00 | CASCADE CARE | CARC 27 · ELIGIBILITY | 895.00 |
| CLM0001338 | 16 Jul 2024 | 401.00 | CASCADE CARE | Not denied | — |
| CLM0001337 | 6 Jul 2024 | 567.00 | CASCADE CARE | Not denied | — |