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SL-2026-0161Ready to file Advance funded

P. Sandoval

Member M-06822 · Spinal Surgery · Pacific Health Network

Member workspace
DN
David Nguyen
Assigned owner
Summary
Member
P. Sandoval
Diagnosis
Spinal Surgery
M48.062
Carrier
Sun Life Financial
Total claims
$215,000
Spec deductible
$175,000
Amount to file
$40,000
claims above spec deductible
Source: Javelina
Packet 19 days old — stale, refresh before submitting
Packet checklist6/7
Draft filing packet
Packet ready to file
Claim ledger
SL-2026-0161-submission-1-claim-ledger.xlsx
Paid claims from Jan 1, 2026 to May 27, 2026
Combined PDF
SL-2026-0161-submission-1-filing-packet.pdf
Auto cover sheet + checklist supporting documents
Submission 1 · Initial filing
Ready-to-file draft packet. Applies the $175,000 spec deductible and requests $40,000 above deductible. Template: Platform reimbursement request form.
Current cumulative paid
$215,000
Last filed cumulative paid
None yet
New eligible paid
$40,000
Filing creation threshold
$500
Current filing record
SL-2026-0161-F01 · Initial filing
Draft
Paid periodJan 1, 2026 to May 27, 2026
Spec applied$175,000
Amount to request$40,000
Cumulative paid through$215,000
Filing threshold$500
Printed claim threshold$10,000

Initial filing applies the specific deductible; request amount is paid claims above deductible.

Claim detail
Claim Details
DateProviderDx codeAmount
2026-02-12Mayo Clinic — NeurosurgeryM48.062$133,300
2026-03-29Mayo Outpatient PTM48.062$47,300
2026-04-28Walgreens PharmacyM48.062$34,400
Total$215,000
Submit packet to carrier
Advance-funded
Plan files first, carrier funds the disbursement, plan mails check to provider. Filing speed = provider wait time.
Documents6/7 required
Pushback risk cleared2/3 cleared
1 carrier pushback risk flagged for review below
Activity
  1. Spec deductible triggered
    May 13, 2026
  2. Filing packet auto-assembled
    May 13, 2026
  3. Core packet review complete
    May 27, 2026·David Nguyen
    Required support documents are in; cover sheet generated for final review before submission
  4. Packet ready · awaiting rep approval to file
    Advance-funded — provider check is on hold pending carrier approval. File now to start the disbursement clock.
Carrier risk checks
Carrier pushback risk