ELENA OKAFOR
Dependent on policy B09M000305
Claims
2
Attributed to this person
Charged
1,540.00
Total submitted
Denied
325.69
2 denied claims
Patient responsibility
540.15
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 | ELENA OKAFOR |
| Role on the policy | Dependent · relationship 01 |
| Policy | B09M000305 |
| Date of birth | 31 Oct 2001 |
| Plan | GOLD PPO |
| Covered from | 26 Mar 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 50 · Other | 1 | 540.15 |
| Total | 540.15 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001256 | 7 Mar 2025 | 709.00 | CASCADE CARE | CARC 27 · ELIGIBILITY | 325.69 |
| CLM0001257 | 2 Jun 2024 | 831.00 | CASCADE CARE | CARC 50 · MEDICAL_NECESSITY | 0.00 |