AmeraStop-Loss
OverviewWork QueueReportingGroupsFilingAdmin
Back to team queue
SL-2026-0163Gathering docs Advance funded

J. O'Brien

Member M-07088 · Trauma Surgery · Pacific Health Network

Member workspace
DN
David Nguyen
Assigned owner
Summary
Member
J. O'Brien
Diagnosis
Trauma Surgery
S36.298A
Carrier
Sun Life Financial
Total claims
$196,000
Spec deductible
$175,000
Amount to file
$21,000
claims above spec deductible
Source: Javelina
Packet 21 days old — stale, refresh before submitting
Packet checklist6/8
Draft filing packet
Packet ready to file
Claim ledger
SL-2026-0163-submission-1-claim-ledger.xlsx
Paid claims from Jan 1, 2026 to May 25, 2026
Combined PDF
SL-2026-0163-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 $21,000 above deductible. Template: Platform reimbursement request form.
Current cumulative paid
$196,000
Last filed cumulative paid
None yet
New eligible paid
$21,000
Filing creation threshold
$500
Current filing record
SL-2026-0163-F01 · Initial filing
Draft
Paid periodJan 1, 2026 to May 25, 2026
Spec applied$175,000
Amount to request$21,000
Cumulative paid through$196,000
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
2026-02-15Penn Trauma CenterS36.298A$121,520
2026-04-01Penn Step-DownS36.298A$43,120
2026-05-01Specialty PharmacyS36.298A$31,360
Total$196,000
Submit packet to carrier
Advance-funded
Plan files first, carrier funds the disbursement, plan mails check to provider. Filing speed = provider wait time.
Documents6/8 required
Pushback risk cleared3/3 cleared
Stuck on
Clinical team
Waiting on case-management notes upload
2 days since last meaningful update
Activity
  1. Spec deductible triggered
    May 16, 2026
  2. COBRA enrollment detected — member elected COBRA after 2025-12 termination
    May 19, 2026
  3. Filing packet auto-assembled (6 of 7 docs)
    May 16, 2026
  4. Awaiting case mgmt CSV upload from clinical team
    May 25, 2026·David Nguyen
  5. Almost ready · only case management notes outstanding
    Case management notes are the last item — clinical team upload pending.
Carrier risk checks
Carrier pushback risk