VICTOR OKAFOR
Dependent on policy B05M000255
Claims
3
Attributed to this person
Charged
1,931.00
Total submitted
Denied
568.00
1 denied claims
Patient responsibility
243.10
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 | VICTOR OKAFOR |
| Role on the policy | Dependent · relationship 19 |
| Policy | B05M000255 |
| Date of birth | 27 Aug 2011 |
| Plan | PLATINUM PPO |
| Covered from | 11 Oct 2024 |
| Covered to | 27 Feb 2025 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 154.60 |
| CARC 1 · Deductible | 1 | 88.50 |
| Total | 243.10 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001047 | 15 Apr 2025 | 568.00 | CASCADE CARE | CARC 27 · ELIGIBILITY | 568.00 |
| CLM0001046 | 20 Feb 2025 | 590.00 | CASCADE CARE | Not denied | — |
| CLM0001045 | 28 Dec 2024 | 773.00 | CASCADE CARE | Not denied | — |