AmeraStop-Loss
OverviewWork QueueReportingGroupsFilingAdmin
Back to team queue
SL-2026-0158Carrier denied

B. Singh

Member M-05544 · Trauma Surgery · Heartland Foods

Member workspace
SP
Sarah Park
Assigned owner
Summary
Member
B. Singh
Diagnosis
Trauma Surgery
S36.298A
Carrier
Sun Life Financial
Total claims
$142,000
Spec deductible
$100,000
Amount to file
$42,000
claims above spec deductible
Filed
$42,000
Reimbursed
$0
Outstanding
$42,000
Source: Javelina
Packet 21 days old — stale, refresh before submitting
Packet checklist7/7
Filing output and history
Filing output
Claim ledger
SL-2026-0158-submission-1-claim-ledger.xlsx
Paid claims from Jan 1, 2026 to May 25, 2026
Combined PDF
SL-2026-0158-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
$142,000
Last filed cumulative paid
$142,000
New eligible paid
$0
Filing creation threshold
$500
Current filing record
SL-2026-0158-F01 · Initial filing
Submitted
Paid periodJan 1, 2026 to May 2, 2026
Spec applied$100,000
Filed amount$42,000
Cumulative paid through$142,000
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
2026-01-07Grady Memorial — Level 1 TraumaS36.298A$88,040
2026-02-21Grady Step-DownS36.298A$31,240
2026-03-23CVS PharmacyS36.298A$22,720
Total$142,000
Communication history
Communication3 messages
From usclaims@sunlifefinancial.com
May 2, 2026
[SL-2026-0158] Trauma Surgery stop-loss filing — B. Singh

Stop-loss claim filing for B. Singh (M-05544). Attached: claim ledger flat file plus combined PDF packet with supporting docs.

SL-2026-0158-claim-ledger.xlsx SL-2026-0158-filing-packet.pdf fee-invoices.pdf um-case-management-notes.pdf aaw-cob-forms.pdf
From carrierclaims@sunlifefinancial.com
May 19, 2026
Re: [SL-2026-0158] Trauma Surgery stop-loss filing — B. Singh

Reason: timely filing question on March DOS

Action: Open appeal within window
From usclaims@sunlifefinancial.com
May 22, 2026
Re: [SL-2026-0158] Trauma Surgery stop-loss filing — B. Singh

With supplemental DOS confirmations from provider

Carrier denied — appeal
Denied 2 days ago
Reason: Reason: timely filing question on March DOS
Standard appeal window: 60 days from denial.
System has the rebuttal pack pre-assembled — review and send.
Stuck on
Carrier
Waiting on denial — appeal needs to be filed
2 days since last meaningful update
Activity
  1. Spec deductible triggered
    Apr 7, 2026
  2. Filed to carrier
    May 2, 2026·Sarah Park
  3. Denial received
    May 19, 2026·Sun Life
    Reason: timely filing question on March DOS
  4. Appeal package submitted
    May 22, 2026·Sarah Park
    With supplemental DOS confirmations from provider
  5. 15-day appeal SLA reminder
    May 25, 2026
  6. Carrier denied · rep needs to review appeal path
    Reason: timely filing question on March DOS
Carrier risk checks
Carrier pushback risk