L. Okafor
Member M-09114 / Cascade Manufacturing / 2026. Notices, threshold events, filing records, reimbursement, and activity stay scoped to this member within the group.
Submission-level view for carrier, client, or internal status questions.
| Submission | Paid period | Requested | Reimbursed | Outstanding | Status |
|---|---|---|---|---|---|
| Submission 2 SL-2026-0098-F02 / Supplemental filing | Apr 8, 2026 to May 16, 2026 | $0 | $0 | $0 | Watching |
| Submission 1 SL-2026-0098-F01 / Initial filing | Jan 1, 2026 to Apr 7, 2026 | $70,000 | $0 | $70,000 | Filed, awaiting carrier |
| Total | $70,000 | $0 | $70,000 | ||
Current stop-loss position for this member in this group and policy year.
Berkley Accident & Health
denied-appeal
No daily notice row
One member can have one 50% notice event and multiple independent filing records after spec is crossed.
Estimated from current paid claims against $150,000 specific deductible.
Member entered the year-end and pre-spec monitoring lane.
$220,000 paid against $150,000 deductible.
SL-2026-0098-F01, filed amount $70,000.
SL-2026-0098-F02, $0 new eligible paid against $1,000 threshold.
Daily notices are one-time carrier notices. Older rows remain here as audit history.
Each filing is separate. Subsequent filings compare new eligible paid claims against the configured filing creation threshold.
Future treatment would open as a separate filing once new eligible paid claims meet the configured filing creation threshold.
Initial filing applied the specific deductible and set the last filed cumulative paid amount for future filings.
Paid claim lines that feed notice percentages and filing packets.
| Date | Provider | Dx | Case | Amount |
|---|---|---|---|---|
| Feb 26, 2026 | Optum Specialty Pharmacy | C50.912 | SL-2026-0098 | $35,200 |
| Jan 27, 2026 | Mayo Infusion | C50.912 | SL-2026-0098 | $48,400 |
| Dec 13, 2025 | Mayo Clinic — Oncology | C50.912 | SL-2026-0098 | $136,400 |
System, rep, carrier, notice, and filing events in one history.
Adding two prior approval references from same carrier before submitting; targeting tomorrow
System pulled plan-doc Section 4.2 in full plus comparable approved cases at the same carrier; rebuttal cites direct contradiction of exclusion 4.2(c)
Reason: "Service not covered by contract" — citing exclusion 4.2(c). Appeal window 60 days.
SL-2026-0098-F01 for $70,000