ELENA OKAFOR
Dependent on policy B02M000202
Claims
3
Attributed to this person
Charged
1,940.00
Total submitted
Denied
1,159.00
2 denied claims
Patient responsibility
50.00
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 | B02M000202 |
| Date of birth | 17 Jan 1984 |
| Plan | GOLD PPO |
| Covered from | 17 Sep 2024 |
| Covered to | 11 Dec 2024 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 3 · Copay | 1 | 50.00 |
| Total | 50.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000895 | 10 Jan 2025 | 805.00 | MERIDIAN HEALTH PLAN | CARC 27 · ELIGIBILITY | 805.00 |
| CLM0000896 | 27 Dec 2024 | 354.00 | MERIDIAN HEALTH PLAN | CARC 27 · ELIGIBILITY | 354.00 |
| CLM0000894 | 6 Sep 2024 | 781.00 | MERIDIAN HEALTH PLAN | Not denied | — |