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SL-2026-0180Gathering docs

T. Wong

Member M-11975 · Transplant · Northern Logistics Co

Member workspace
JT
James Torres
Assigned owner
Summary
Member
T. Wong
Diagnosis
Transplant
C92.00
Carrier
Berkley Accident & Health
Total claims
$268,000
Spec deductible
$100,000
Amount to file
$168,000
claims above spec deductible
Source: Cigna
Packet 22 days old — stale, refresh before submitting
Packet checklist2/7
Draft filing packet
Packet ready to file
Claim ledger
SL-2026-0180-submission-1-claim-ledger.xlsx
Paid claims from Jan 1, 2026 to May 24, 2026
Combined PDF
SL-2026-0180-submission-1-filing-packet.pdf
Auto cover sheet + checklist supporting documents
Submission 1 · Initial filing
Ready-to-file draft packet. Applies the $100,000 spec deductible and requests $168,000 above deductible. Template: Platform reimbursement request form.
Current cumulative paid
$268,000
Last filed cumulative paid
None yet
New eligible paid
$168,000
Filing creation threshold
$1,000
Current filing record
SL-2026-0180-F01 · Initial filing
Draft
Paid periodJan 1, 2026 to May 24, 2026
Spec applied$100,000
Amount to request$168,000
Cumulative paid through$268,000
Filing threshold$1,000
Printed claim threshold$10,000

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

Claim detail
Claim Details
DateProviderDx codeAmount
2026-01-30Mayo Clinic — RochesterC92.00$147,400
2026-02-14Mayo Clinic — OutpatientC92.00$48,240
2026-03-21Walgreens Specialty RxC92.00$32,160
2026-04-30Mayo Clinic — Follow-upC92.00$40,200
Total$268,000
Submit packet to carrier
Funding pending — waiting on Accounting
Plan-account wire from employer is in flight (typically clears within 5 business days). Once the plan pays the underlying claims, we can file for the amount above spec.
Documents2/7 required
Pushback risk cleared2/3 cleared
1 carrier pushback risk flagged for review below
Stuck on
HR
Waiting on active-at-work attestation
3 days since last meaningful update
Activity
  1. Spec deductible triggered
    May 20, 2026
  2. Filing packet auto-assembled
    May 20, 2026
    Pre-cert, COB, and claim ledger pulled. HR AAW email fired in parallel.
  3. Active-at-work email sent to Northern Logistics HR
    May 20, 2026
  4. AAW auto follow-up #1 sent — no reply yet
    May 23, 2026
  5. 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