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SL-2025-9912ResolvedCaught up Advance funded
I. Vargas
Member M-02055 · Cardiac Surgery · Cascade Manufacturing
Member workspaceMC
Maria Chen
Assigned owner
Summary
Member
I. Vargas
Diagnosis
Cardiac Surgery
I50.43
Carrier
Tokio Marine HCC
Total claims
$180,000
Spec deductible
$150,000
Amount to file
$30,000
claims above spec deductible
Filed
$30,000
Reimbursed
$30,000
Source: Javelina
Packet 79 days old — stale, refresh before submitting
Packet checklist7/7
Filing output and history
Filing output
Claim ledger
SL-2025-9912-submission-2-claim-ledger.xlsx
Paid claims from Dec 29, 2025 to Mar 28, 2026
Combined PDF
SL-2025-9912-submission-2-filing-packet.pdf
Auto cover sheet + checklist supporting documents
Submission 2 · Subsequent incremental filing
Subsequent filing is incremental: new eligible paid claims since the last filed cumulative paid amount. Template: Platform reimbursement request form.
Current cumulative paid
$180,000
Last filed cumulative paid
$180,000
New eligible paid
$0
Filing creation threshold
$0
Filing records for this member
SL-2025-9912-F01 · Initial filing
ReimbursedPaid periodJan 1, 2026 to Dec 28, 2025
Spec applied$150,000
Filed amount$30,000
Cumulative paid through$180,000
Filing threshold$0
Printed claim threshold$10,000
Initial filing applied the specific deductible and set the last filed cumulative paid amount for future filings.
SL-2025-9912-F02 · Subsequent filing
WatchingPaid periodDec 29, 2025 to Mar 28, 2026
Spec applied$0
New eligible paidNo new paid claims yet
Cumulative paid through$180,000
Filing threshold$0
Printed claim threshold$10,000
Future treatment would open as a separate filing once new eligible paid claims meet the configured filing creation threshold.
Claim detail
Claim Details
| Date | Provider | Dx code | Amount |
|---|---|---|---|
| 2025-08-30 | Cleveland Clinic — Heart Center | I50.43 | $111,600 |
| 2025-10-14 | Cleveland Clinic Outpatient | I50.43 | $39,600 |
| 2025-11-13 | Specialty Pharmacy | I50.43 | $28,800 |
| Total | $180,000 | ||
Communication history
Communication2 messages
From usclaims@tokiomarinehcc.com
Dec 28, 2025[SL-2025-9912] Cardiac Surgery stop-loss filing — I. Vargas
Stop-loss claim filing for I. Vargas (M-02055). Attached: claim ledger flat file plus combined PDF packet with supporting docs.
SL-2025-9912-claim-ledger.xlsx SL-2025-9912-filing-packet.pdf fee-invoices.pdf um-case-management-notes.pdf aaw-cob-forms.pdf
From carrierclaims@tokiomarinehcc.com
Mar 28, 2026Re: [SL-2025-9912] Cardiac Surgery stop-loss filing — I. Vargas
Approved and processed.
Resolved
Total reimbursed$30,000
Case closed and archived.
Activity
- Spec deductible triggeredNov 28, 2025
- Filed to carrierDec 28, 2025·Maria Chen
- Reimbursement receivedMar 28, 2026·Tokio Marine HCC
- Case closedMar 28, 2026
- Resolved · case closedCase archived. No further action.
Carrier risk checks
Carrier pushback risk