GRACE OKAFOR
Subscriber on policy B05M000584
Claims
1
Attributed to this person
Charged
634.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
95.10
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 | Subscriber |
| Policy | B05M000584 |
| Date of birth | 21 May 1990 |
| Plan | BRONZE EPO |
| Covered from | 25 Dec 2024 |
| Covered to | 9 Jul 2025 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 95.10 |
| Total | 95.10 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002486 | 24 Mar 2025 | 634.00 | MERIDIAN HEALTH PLAN | Not denied | — |