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SL-2026-0119Info requested Advance funded

R. Patel

Member M-04421 · Cardiac Surgery · Northern Logistics Co

Member workspace
JT
James Torres
Assigned owner
Summary
Member
R. Patel
Diagnosis
Cardiac Surgery
I50.43
Carrier
Tokio Marine HCC
Total claims
$188,000
Spec deductible
$100,000
Amount to file
$88,000
claims above spec deductible
Filed
$88,000
Reimbursed
$0
Outstanding
$88,000
Source: Cigna
Packet 31 days old — stale, refresh before submitting
Packet checklist7/7
Filing output and history
Filing output
Claim ledger
SL-2026-0119-submission-2-claim-ledger.xlsx
Paid claims from Apr 23, 2026 to May 15, 2026
Combined PDF
SL-2026-0119-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
$188,000
Last filed cumulative paid
$188,000
New eligible paid
$0
Filing creation threshold
$0
Filing records for this member
SL-2026-0119-F01 · Initial filing
Submitted
Paid periodJan 1, 2026 to Apr 22, 2026
Spec applied$100,000
Filed amount$88,000
Cumulative paid through$188,000
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-2026-0119-F02 · Subsequent filing
Watching
Paid periodApr 23, 2026 to May 15, 2026
Spec applied$0
New eligible paidNo new paid claims yet
Cumulative paid through$188,000
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
DateProviderDx codeAmount
2025-12-28Northwestern Memorial — CardiacI50.43$116,560
2026-02-11Northwestern Cardiac RehabI50.43$41,360
2026-03-13Northwestern OutpatientI50.43$30,080
Total$188,000
Communication history
Communication2 messages
From usclaims@tokiomarinehcc.com
Apr 22, 2026
[SL-2026-0119] Cardiac Surgery stop-loss filing — R. Patel

Stop-loss claim filing for R. Patel (M-04421). Attached: claim ledger flat file plus combined PDF packet with supporting docs.

SL-2026-0119-claim-ledger.xlsx SL-2026-0119-filing-packet.pdf fee-invoices.pdf um-case-management-notes.pdf aaw-cob-forms.pdf
From carrierclaims@tokiomarinehcc.com
May 15, 2026
Re: [SL-2026-0119] Cardiac Surgery stop-loss filing — R. Patel

Carrier requested itemized hospital bill for $48K of charges before reviewing remainder.

Action: Pull itemized bill from provider portal and reply
Carrier asked for info
Days waiting on us: 12
Itemized bill request
Hospital itemization needed for $48K of charges
System has the response drafted from existing case data — review and send.
Stuck on
Provider billing office
Waiting on itemized hospital bill
12 days since last meaningful update
Activity
  1. Spec deductible triggered
    Mar 28, 2026
  2. Filed to carrier
    Apr 22, 2026·James Torres
  3. Itemized bill request
    May 15, 2026·Tokio Marine HCC
    Hospital itemization needed for $48K of charges
  4. Provider portal request submitted
    May 16, 2026·James Torres
    Requested itemized bill from Northwestern Memorial via their provider portal
  5. Provider portal auto follow-up sent
    May 21, 2026
  6. Called billing office
    May 25, 2026·James Torres
    Provider promised to release the itemization within 48 hours
  7. Carrier requested more info · rep needs to respond
    Hospital itemization needed for $48K of charges
Carrier risk checks
Carrier pushback risk