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SL-2026-0145Filed — pendingCaught up Advance funded

D. Martinez

Member M-06622 · Cardiac Surgery · Pacific Health Network

Member workspace
DN
David Nguyen
Assigned owner
Summary
Member
D. Martinez
Diagnosis
Cardiac Surgery
I50.43
Carrier
Sun Life Financial
Total claims
$200,000
Spec deductible
$175,000
Amount to file
$25,000
claims above spec deductible
Filed
$25,000
Reimbursed
$0
Outstanding
$25,000
Source: Javelina
Packet 41 days old — stale, refresh before submitting
Packet checklist7/7
Filing output and history
Filing output
Claim ledger
SL-2026-0145-submission-2-claim-ledger.xlsx
Paid claims from May 6, 2026 to May 5, 2026
Combined PDF
SL-2026-0145-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
$200,000
Last filed cumulative paid
$200,000
New eligible paid
$0
Filing creation threshold
$500
Filing records for this member
SL-2026-0145-F01 · Initial filing
Submitted
Paid periodJan 1, 2026 to May 5, 2026
Spec applied$175,000
Filed amount$25,000
Cumulative paid through$200,000
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.

SL-2026-0145-F02 · Subsequent filing
Watching
Paid periodMay 6, 2026 to May 5, 2026
Spec applied$0
New eligible paidNo new paid claims yet
Cumulative paid through$200,000
Filing threshold$500
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
2026-01-22Cleveland Clinic — Heart CenterI50.43$124,000
2026-03-08Cleveland Clinic OutpatientI50.43$44,000
2026-04-07Specialty PharmacyI50.43$32,000
Total$200,000
Communication history
Communication1 message
From usclaims@sunlifefinancial.com
May 5, 2026
[SL-2026-0145] Cardiac Surgery stop-loss filing — D. Martinez

Stop-loss claim filing for D. Martinez (M-06622). Attached: claim ledger flat file plus combined PDF packet with supporting docs.

SL-2026-0145-claim-ledger.xlsx SL-2026-0145-filing-packet.pdf fee-invoices.pdf um-case-management-notes.pdf aaw-cob-forms.pdf
Awaiting carrier
Filed 41 days ago. Auto follow-up at 7 day SLA.
Last update 22 days ago. Our work is done — pinging carrier if needed.
Stuck on
Carrier
Waiting on carrier review
22 days since last meaningful update
Activity
  1. Spec deductible triggered
    Apr 22, 2026
  2. Filed to carrier
    May 5, 2026·David Nguyen
  3. 21-day carrier follow-up due
    May 26, 2026
    No carrier response 21 days after filing; status request is due.
  4. Filed and waiting · monitoring for carrier response
    22 days since filed. Auto follow-up on carrier scheduled at SLA.
Carrier risk checks
Carrier pushback risk