AmeraStop-Loss
Member stop-loss workspace

P. Sandoval

Member M-06822 / Pacific Health Network / 2026. Notices, threshold events, filing records, reimbursement, and activity stay scoped to this member within the group.

Open active filing
% of spec
123%
$215,000 paid
Spec deductible
$175,000
Spinal Surgery
Filing records
1
1 open or draft
Outstanding
$0
$0 reimbursed
Printable filing summary

Submission-level view for carrier, client, or internal status questions.

SubmissionPaid periodRequestedReimbursedOutstandingStatus
Submission 1
SL-2026-0161-F01 / Initial filing
Jan 1, 2026 to May 27, 2026$40,000$0$40,000Draft
Total$40,000$0$40,000
Member summary

Current stop-loss position for this member in this group and policy year.

Group
Pacific Health Network

Sun Life Financial

Owner
David Nguyen

ready-to-file

Highest diagnosis
Spinal Surgery
Case management
Not marked open

No daily notice row

Threshold timeline

One member can have one 50% notice event and multiple independent filing records after spec is crossed.

50% threshold crossed
Apr 13, 2026

Estimated from current paid claims against $175,000 specific deductible.

75% watch reached
Apr 29, 2026

Member entered the year-end and pre-spec monitoring lane.

Specific deductible crossed
May 13, 2026

$215,000 paid against $175,000 deductible.

Initial filing staged
May 27, 2026

SL-2026-0161-F01, draft amount $40,000.

50% notices

Daily notices are one-time carrier notices. Older rows remain here as audit history.

No 50% notice rows for this member.
Claim ledger

Paid claim lines that feed notice percentages and filing packets.

DateProviderDxCaseAmount
Apr 28, 2026Walgreens PharmacyM48.062SL-2026-0161$34,400
Mar 29, 2026Mayo Outpatient PTM48.062SL-2026-0161$47,300
Feb 12, 2026Mayo Clinic — NeurosurgeryM48.062SL-2026-0161$133,300