HENRY OKAFOR
Dependent on policy B03M000675
Claims
2
Attributed to this person
Charged
702.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
30.00
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 | HENRY OKAFOR |
| Role on the policy | Dependent · relationship 01 |
| Policy | B03M000675 |
| Date of birth | 14 Dec 1942 |
| Plan | GOLD PPO |
| Covered from | 2 Aug 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 3 · Copay | 1 | 30.00 |
| Total | 30.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002801 | 19 Apr 2026 | 571.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0002802 | 7 Oct 2024 | 131.00 | NORTHSTAR MUTUAL | Not denied | — |