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SL-2026-0177Filed — pendingCaught up Advance funded

N. Ali

Member M-09920 · Spinal Surgery · Pacific Health Network

Member workspace
DN
David Nguyen
Assigned owner
Summary
Member
N. Ali
Diagnosis
Spinal Surgery
M48.062
Carrier
Sun Life Financial
Total claims
$195,000
Spec deductible
$175,000
Amount to file
$20,000
claims above spec deductible
Filed
$20,000
Reimbursed
$0
Outstanding
$20,000
Source: Javelina
Packet 27 days old — stale, refresh before submitting
Packet checklist7/7
Filing output and history
Filing output
Claim ledger
SL-2026-0177-submission-1-claim-ledger.xlsx
Paid claims from Jan 1, 2026 to May 19, 2026
Combined PDF
SL-2026-0177-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
$195,000
Last filed cumulative paid
$195,000
New eligible paid
$0
Filing creation threshold
$500
Current filing record
SL-2026-0177-F01 · Initial filing
Submitted
Paid periodJan 1, 2026 to May 19, 2026
Spec applied$175,000
Filed amount$20,000
Cumulative paid through$195,000
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
2026-02-06Hospital for Special Surgery — SpineM48.062$120,900
2026-03-23HSS OutpatientM48.062$42,900
2026-04-22Specialty PharmacyM48.062$31,200
Total$195,000
Communication history
Communication1 message
From usclaims@sunlifefinancial.com
May 19, 2026
[SL-2026-0177] Spinal Surgery stop-loss filing — N. Ali

Stop-loss claim filing for N. Ali (M-09920). Attached: claim ledger flat file plus combined PDF packet with supporting docs.

SL-2026-0177-claim-ledger.xlsx SL-2026-0177-filing-packet.pdf fee-invoices.pdf um-case-management-notes.pdf aaw-cob-forms.pdf
Awaiting carrier
Filed 27 days ago. Auto follow-up at 7 day SLA.
Last update 8 days ago. Our work is done — pinging carrier if needed.
Stuck on
Carrier
Waiting on carrier review
8 days since last meaningful update
Activity
  1. Spec deductible triggered
    May 7, 2026
  2. Filed to carrier
    May 19, 2026·David Nguyen
  3. Filed and waiting · monitoring for carrier response
    8 days since filed. Auto follow-up on carrier scheduled at SLA.
Carrier risk checks
Carrier pushback risk