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SL-2026-0088ApprovedCaught up Advance funded

F. Brown

Member M-07712 · Trauma Surgery · Pacific Health Network

Member workspace
DN
David Nguyen
Assigned owner
Summary
Member
F. Brown
Diagnosis
Trauma Surgery
S36.298A
Carrier
Sun Life Financial
Total claims
$198,000
Spec deductible
$175,000
Amount to file
$23,000
claims above spec deductible
Filed
$23,000
Reimbursed
$0
Outstanding
$23,000
Source: Javelina
Packet 21 days old — stale, refresh before submitting
Packet checklist7/7
Filing output and history
Filing output
Claim ledger
SL-2026-0088-submission-1-claim-ledger.xlsx
Paid claims from Jan 1, 2026 to May 25, 2026
Combined PDF
SL-2026-0088-submission-1-filing-packet.pdf
Auto cover sheet + checklist supporting documents
Submission 1 · Initial filing
Initial filing includes all paid claims from plan start through current paid date. Template: Platform reimbursement request form.
Current cumulative paid
$198,000
Last filed cumulative paid
$198,000
New eligible paid
$0
Filing creation threshold
$500
Current filing record
SL-2026-0088-F01 · Initial filing
Submitted
Paid periodJan 1, 2026 to Apr 2, 2026
Spec applied$175,000
Filed amount$23,000
Cumulative paid through$198,000
Filing threshold$500
Printed claim threshold$10,000

Initial filing applied the specific deductible and set the last filed cumulative paid amount for future filings.

Claim detail
Claim Details
DateProviderDx codeAmount
2025-12-08Grady Memorial — Level 1 TraumaS36.298A$122,760
2026-01-22Grady Step-DownS36.298A$43,560
2026-02-21CVS PharmacyS36.298A$31,680
Total$198,000
Communication history
Communication2 messages
From usclaims@sunlifefinancial.com
Apr 2, 2026
[SL-2026-0088] Trauma Surgery stop-loss filing — F. Brown

Stop-loss claim filing for F. Brown (M-07712). Attached: claim ledger flat file plus combined PDF packet with supporting docs.

SL-2026-0088-claim-ledger.xlsx SL-2026-0088-filing-packet.pdf fee-invoices.pdf um-case-management-notes.pdf aaw-cob-forms.pdf
From carrierclaims@sunlifefinancial.com
May 7, 2026
Re: [SL-2026-0088] Trauma Surgery stop-loss filing — F. Brown

Spec reimbursement of $23,000 (claims above spec) approved

Full reimbursement
Total reimbursed$0
Awaiting close-out audit.
Activity
  1. Spec deductible triggered
    Mar 8, 2026
    Advance-funded case — provider check on hold pending stop-loss approval
  2. Filed to carrier
    Apr 2, 2026·David Nguyen
  3. Approved
    May 7, 2026·Sun Life
    Spec reimbursement of $23,000 (claims above spec) approved
  4. Carrier funds received
    May 25, 2026
    Carrier funds cleared; provider check #3091845 mailed
  5. Reimbursement received · awaiting close-out
    Total reimbursed: $0K. No further action needed.
Carrier risk checks
Carrier pushback risk