ELENA OKAFOR
Subscriber on policy B02M000647
Claims
3
Attributed to this person
Charged
782.00
Total submitted
Denied
461.00
1 denied claims
Patient responsibility
38.55
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 | Subscriber |
| Policy | B02M000647 |
| Date of birth | 22 Jul 1968 |
| Plan | GOLD PPO |
| Covered from | 16 Oct 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 38.55 |
| Total | 38.55 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002726 | 20 Jul 2026 | 257.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0002724 | 3 Jan 2025 | 64.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0002725 | 17 Oct 2024 | 461.00 | NORTHSTAR MUTUAL | CARC 29 · TIMELY_FILING | 461.00 |