Audit Cases

99% bill reduction after outpatient treatment for neck and back pain

Comprehensive line-by-line claim auditing by healthcare professionals is used to uncover errors typically not caught. ClaimDOC publishes a sample of five recent client savings audit results bi-monthly. See the savings below and know that together we can make healthcare affordable.

1. Houston, TX

Hospital outpatient services for the treatment of neck and back pain following a motor vehicle accident

High-Dollar Services:

  • CT Scans: $94,688.63

Savings Summary:

  • Billed Charges: $110,480.76
  • ClaimDOC Allowed: $1,044.17
  • Plan Savings: $109,436.59
  • Reduction: 99%

2. Bridgeport, CT

Physician services for reconstructive breast surgery due to breast cancer

  • Surgery: $148,800
  • Billed Charges: $148,800
  • ClaimDOC Allowed: $2,949.74
  • Plan Savings: $145,850.26
  • Reduction: 98%
High-Dollar Services: Savings Summary:

3. Rockledge, FL

Hospital outpatient services for treatment of ovarian cyst, excessive menstruation and related surgery

  • Operating Room: $135,172.78
  • Anesthesia: $11,817.82
  • Billed Charges: $168,833.88
  • ClaimDOC Allowed: $11,479.46
  • Plan Savings: $157,354.42
  • Reduction: 93%
High-Dollar Services: Savings Summary:

4. Mount Pleasant, SC

Hospital outpatient services for the treatment of vaginal prolapse, incontinence and related surgery

  • Pharmacy: $42,935.59
  • CT Scans: $33,730
  • Operating Room: $28,912
  • Laboratory: $22,072
  • Billed Charges: $103,389.42
  • ClaimDOC Allowed: $9,897.79
  • Plan Savings: $93,491.63
  • Reduction: 90%
High-Dollar Services: Savings Summary:

5. Reidsville, GA

One-day hospital stay for the treatment of displaced vertebral fixation device and related surgery

High-Dollar Services:

  • Operating Room: $104,659.20
  • Implants: $26,888

Savings Summary:

  • Billed Charges: $138,162.83
  • ClaimDOC Allowed: $14,892.94
  • Plan Savings: $123,269.89
  • Reduction: 89%

Disclaimer – The analysis of any medical billing or coding is dependent on numerous facts, regulations, payer policies, and codes, as well as the controlling plan description. The information contained herein is intended to provide a real-life example of opportunities for savings through ClaimDOC services but is not intended to provide medical, legal, or financial advice.