DAVID OKAFOR
Dependent on policy B07M000353
Claims
1
Attributed to this person
Charged
506.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
101.20
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 | B07M000353 |
| Date of birth | 14 Sep 1963 |
| Plan | GOLD PPO |
| Covered from | 18 Jun 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 101.20 |
| Total | 101.20 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001500 | 27 May 2025 | 506.00 | NORTHSTAR MUTUAL | Not denied | — |