GRACE OKAFOR
Dependent on policy B03M000439
Claims
3
Attributed to this person
Charged
2,032.00
Total submitted
Denied
882.00
1 denied claims
Patient responsibility
15.00
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 | GRACE OKAFOR |
| Role on the policy | Dependent · relationship 19 |
| Policy | B03M000439 |
| Date of birth | 22 Dec 2016 |
| Plan | SILVER HMO |
| Covered from | 26 May 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 3 · Copay | 1 | 15.00 |
| Total | 15.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001804 | 4 Jul 2025 | 637.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0001805 | 31 May 2025 | 513.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0001803 | 18 May 2025 | 882.00 | NORTHSTAR MUTUAL | CARC 26 · ELIGIBILITY | 882.00 |