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SL-2026-0167Gathering docs Advance funded

A. Lopez

Member M-07733 · NICU · Pacific Health Network

Member workspace
MC
Maria Chen
Assigned owner
Summary
Member
A. Lopez
Diagnosis
NICU
P07.25
Carrier
Sun Life Financial
Total claims
$198,000
Spec deductible
$175,000
Amount to file
$23,000
claims above spec deductible
Source: Javelina
Packet 20 days old — stale, refresh before submitting
Packet checklist2/7
Draft filing packet
Packet ready to file
Claim ledger
SL-2026-0167-submission-1-claim-ledger.xlsx
Paid claims from Jan 1, 2026 to May 26, 2026
Combined PDF
SL-2026-0167-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 $23,000 above deductible. Template: Platform reimbursement request form.
Current cumulative paid
$198,000
Last filed cumulative paid
None yet
New eligible paid
$23,000
Filing creation threshold
$500
Current filing record
SL-2026-0167-F01 · Initial filing
Draft
Paid periodJan 1, 2026 to May 26, 2026
Spec applied$175,000
Amount to request$23,000
Cumulative paid through$198,000
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
2026-02-23UCSF Benioff Children's — NICUP07.25$142,560
2026-03-10UCSF ImagingP07.25$31,680
2026-04-24BabySteps Pediatric SpecialtyP07.25$23,760
Total$198,000
Submit packet to carrier
Advance-funded
Plan files first, carrier funds the disbursement, plan mails check to provider. Filing speed = provider wait time.
Documents2/7 required
Pushback risk cleared3/3 cleared
Stuck on
HR
Waiting on active-at-work attestation
1 day since last meaningful update
Activity
  1. Spec deductible triggered
    May 19, 2026
    Advance-funded case — provider check on hold pending stop-loss filing
  2. Filing packet auto-assembled
    May 19, 2026
    Core filing docs pulled automatically (claim ledger, pre-cert, COB, COBRA). HR email + UM request fired in parallel.
  3. Active-at-work email sent to Pacific Health HR
    May 19, 2026
  4. AAW auto follow-up #1 sent — no reply yet
    May 22, 2026
  5. AAW auto follow-up #2 sent
    May 25, 2026
  6. Waiting on employer HR · active-at-work attestation pending
    HR has been emailed for the active-at-work attestation. Auto follow-up at day 2.
Carrier risk checks
Carrier pushback risk